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KMID : 0371420200990020097
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Annals of Surgical Treatment and Research
2020 Volume.99 No. 2 p.97 ~ p.109
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Oncologic effects of adjuvant chemotherapy in patients with ypT0?2N0 rectal cancer after neoadjuvant chemoradiotherapy and curative surgery: a meta-analysis
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Ha Gi-Won
Lee Min-Ro
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Abstract
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Purpose: The role of adjuvant chemotherapy for patients with ypT0?2N0 rectal cancer following neoadjuvant chemoradiotherapy (nCRT) and curative surgery is uncertain. We performed a meta-analysis using selected studies to compare adjuvant chemotherapy with observation for this cohort of patients.
Methods: PubMed, Embase, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random effect models. Outcome measures were 5-year overall survival (OS), disease-free survival (DFS), local, and distant recurrence.
Results: We included 17 nonrandomized studies for qualitative analysis and 16 nonrandomized studies that examined 4,747 patients for the meta-analysis. In analysis of patients with ypT0N0 rectal cancer, adjuvant chemotherapy had no significant effect on OS (odds ratio [OR], 1.53; 95% confidence interval [CI], 0.86?2.72; I2 = 27%), DFS (OR, 1.22; 95% CI, 0.61?2.42; I2 = 5%), local recurrence (OR, 0.78; 95% CI, 0.08?7.37; I2 = 0%), and distant recurrence (OR, 1.04; 95% CI, 0.41?2.62; I2 = 0%). In analysis of patients with ypT1?2N0 rectal cancer, adjuvant chemotherapy also had no significant effect on OS (OR, 2.15; 95% CI, 0.59?7.80; I2 = 26%), DFS (OR, 1.66; 95% CI, 0.35?7.85; I2 = 44%), local recurrence (OR, 2.56; 95% CI, 0.72?9.13; I2 = 0%), and distant recurrence (OR, 1.15; 95% CI, 0.23?5.87; I2 = 0%).
Conclusion: Adjuvant chemotherapy may have no oncologic benefits in patients with ypT0?2N0 rectal cancer after nCRT and radical surgery. Routine use of adjuvant chemotherapy for those patients may be avoided.
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KEYWORD
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Adjuvant chemotherapy, Chemoradiotherapy, Prognosis, Rectal neoplasms
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