Adjuvant chemotherapy and survival outcomes in rectal cancer patients with good response (ypT0-2N0) after neoadjuvant chemoradiotherapy and surgery: A retrospective nationwide analysis

Kuo, Yu‐Hsuan; Lin, Yun-Tzu; Ho, Chung‐Han; Chou, Chia-Lin; Cheng, Li-Chin; Tsai, C. Jillian; Hong, Wei-Ju; Chen, Yi‐Chen; Yang, Ching‐Chieh

doi:10.3389/fonc.2022.1087778

Cited by 4 publications

(7 citation statements)

References 39 publications

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“…A total of 29 [ 15 – 19 , 26 , 28 – 31 , 33 – 52 ]. studies, including 9 [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…For the pooled analysis, we only included the most recently published studies from this database. Given the 18 [ 16 , 17 , 19 , 28 , 30 , 33 , 34 , 36 , 37 , 40 – 42 , 44 – 46 , 50 – 52 ]. studies with reporting on the effect of ACT on the hazard ratio of OS in patients with rectal cancer in pCR, the pooled analysis showed that ACT improved overall survival (HR = 0.803, 95% CI 0.678–0.952, P = 0.011) without any observed heterogeneity ( I 2 = 0%, χ 2 = 14.66, P = 0.620) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…2 A). Additionally, 19 [ 15 – 17 , 19 , 28 , 30 , 33 , 34 , 36 , 37 , 40 – 42 , 45 , 46 , 49 , 51 , 52 , 54 ]. studies reported on the 5-year OS rate, and the analysis revealed that patients with pCR who underwent ACT had a higher 5-year OS rate than those who did not receive ACT (OR = 1.605, 95% CI 1.183–2.177, P = 0.002).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen [ 15 – 17 , 28 , 33 , 34 , 37 , 40 , 44 , 48 , 50 – 52 ]. studies compared the effect of ACT and non-ACT on DFS in rectal cancer patients who achieved a pCR.…”

Section: Resultsmentioning

confidence: 99%

“…3 A). Furthermore, 11 [ 15 – 17 , 28 , 33 , 34 , 37 , 40 , 48 , 51 , 52 ]. studies examined the effect of ACT on the 5-year DFS rates in patients with pCR.…”

Section: Resultsmentioning

confidence: 99%

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Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Yang,

Deng,

Cheng

et al. 2024

World J Surg Onc

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Background Locally advanced rectal cancer is typically treated using a combination of neoadjuvant chemoradiotherapy and total mesorectal resection. While achieving pathological complete response following neoadjuvant chemoradiotherapy has been recognized as a positive prognostic factor in oncology, the necessity of adjuvant chemotherapy for locally advanced rectal cancer patients with pathological complete response after surgery remains uncertain. The objective of this meta-analysis was to examine the impact of adjuvant chemotherapy on the oncological outcomes of rectal cancer patients who attain pathological complete response after neoadjuvant chemoradiotherapy. Methods This meta-analysis followed the guidelines outlined in the preferred reporting items for systematic review and meta-analysis (PRISMA). The Web of Science, PubMed, and Cochrane Library databases were systematically searched to identify relevant literature. Results A total of 34 retrospective studies, including 9 studies from the NCBD database, involving 31,558 patients with pathological complete response rectal cancer, were included in the meta-analysis. The included studies were published between 2008 and 2023. The pooled analysis demonstrated that adjuvant chemotherapy significantly improved overall survival (HR = 0.803, 95% CI 0.678–0.952, P = 0.011), and no heterogeneity was observed (I2 = 0%). Locally advanced rectal cancer patients with pathological complete response who underwent adjuvant chemotherapy exhibited a higher 5-year overall survival rate compared to those who did not receive adjuvant chemotherapy (OR = 1.605, 95% CI 1.183–2.177, P = 0.002). However, the analysis also revealed that postoperative ACT did not lead to improvements in disease-free survival and recurrence-free survival within the same patient population. Subgroup analysis indicated that pathological complete response patients with clinical stage T3/T4, lymph node positivity, and younger than 70 years of age may benefit from adjuvant chemotherapy in terms of overall survival. Conclusions The findings of this meta-analysis suggest that adjuvant chemotherapy has a beneficial effect on improving overall survival among rectal cancer patients with pathological complete response. However, no such association was observed in terms of disease-free survival and recurrence-free survival.

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“…A total of 29 [ 15 – 19 , 26 , 28 – 31 , 33 – 52 ]. studies, including 9 [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Thirteen [ 15 – 17 , 28 , 33 , 34 , 37 , 40 , 44 , 48 , 50 – 52 ]. studies compared the effect of ACT and non-ACT on DFS in rectal cancer patients who achieved a pCR.…”

Section: Resultsmentioning

confidence: 99%

“…3 A). Furthermore, 11 [ 15 – 17 , 28 , 33 , 34 , 37 , 40 , 48 , 51 , 52 ]. studies examined the effect of ACT on the 5-year DFS rates in patients with pCR.…”

Section: Resultsmentioning

confidence: 99%

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Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Yang,

Deng,

Cheng

et al. 2024

World J Surg Onc

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Small molecule inhibitors as adjuvants in cancer immunotherapy: enhancing efficacy and overcoming resistance

Wu,

Feng,

Wang

et al. 2024

Front. Immunol.

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Adjuvant therapy is essential in cancer treatment to enhance primary treatment effectiveness, reduce adverse effects, and prevent recurrence. Small molecule inhibitors as adjuvants in cancer immunotherapy aim to harness their immunomodulatory properties to optimize treatment outcomes. By modulating the tumor microenvironment, enhancing immune cell function, and increasing tumor sensitivity to immunotherapy, small molecule inhibitors have the potential to improve patient responses. This review discusses the evolving use of small molecule inhibitors as adjuvants in cancer treatment, highlighting their role in enhancing the efficacy of immunotherapy and the opportunities for advancing cancer therapies in the future.

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The role of adjuvant chemotherapy in rectal cancer patients with ypT0-2N0 after neoadjuvant chemoradiotherapy

Yang,

Deng,

Chen

et al. 2024

Front. Oncol.

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BackgroundNeoadjuvant chemoradiotherapy has emerged as the established treatment for locally advanced rectal cancer. Nevertheless, there remains a debate regarding the necessity of adjuvant chemotherapy for patients with locally advanced rectal cancer who exhibit a favorable tumor response (ypT0-2N0) after neoadjuvant chemoradiotherapy and surgery. Thus, the objective of this study is to investigate the impact of adjuvant chemotherapy on the oncological prognosis of rectal cancer patients who have a good response to neoadjuvant chemoradiotherapy.Materials and methodsThe study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles were searched in the Web of Science, PubMed, and Cochrane Library databases. The primary outcomes assessed were 5-year overall survival, disease-free survival, cancer-specific survival, recurrence-free survival, local recurrence, and distant metastasis. The data was summarized using a random effects model.ResultsA meta-analysis was conducted using 18 retrospective studies published between 2009 and 2023. The studies included 9 from China and 5 from Korea, involving a total of 6566 patients with ypT0-2N0 rectal cancer after neoadjuvant chemoradiotherapy. The pooled data revealed that adjuvant chemotherapy significantly improved 5-year overall survival (OR=1.75, 95% CI: 1.15-2.65, P=0.008), recurrence-free survival (OR=1.73, 95% CI: 1.20-2.48, P=0.003), and reduced distant metastasis (OR=0.68, 95% CI: 0.51-0.92, P=0.011). However, adjuvant chemotherapy did not have a significant effect on disease-free survival, cancer-specific survival, and local recurrence in ypT0-2N0 rectal cancer. Subgroup analysis indicated that adjuvant chemotherapy was beneficial in improving overall survival for ypT1-2N0 rectal cancer (OR=1.89, 95% CI: 1.13-3.19, P=0.003).ConclusionThe findings of the meta-analysis suggest that adjuvant chemotherapy may provide benefits in terms of oncological outcomes for rectal cancer patients with ypT0-2N0 after neoadjuvant chemoradiotherapy and radical surgery. However, further prospective clinical studies are needed to confirm these findings.

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Adjuvant chemotherapy and survival outcomes in rectal cancer patients with good response (ypT0-2N0) after neoadjuvant chemoradiotherapy and surgery: A retrospective nationwide analysis

Cited by 4 publications

References 39 publications

Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Small molecule inhibitors as adjuvants in cancer immunotherapy: enhancing efficacy and overcoming resistance

The role of adjuvant chemotherapy in rectal cancer patients with ypT0-2N0 after neoadjuvant chemoradiotherapy

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