The benefits of adjuvant chemotherapy are associated with the kind of neoadjuvant therapy in stage ypI rectal cancer: evidence based on population analysis

Liao, Hualin; Li, Tao; Liang, Yahang; Liu, Yaxiong; Yuan, Yuli; Li, Mingming; Li, Aidi; Liu, Yang; Yao, Yao; Li, Taiyuan

doi:10.1007/s00384-023-04530-6

Cited by 1 publication

(4 citation statements)

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“…Studies published between 2009 and 2023 were included in this meta-analysis, comprising nine (19,22,30,34,36,38,(40)(41)(42) from China and five (29, 32, 33, 35, 39) from Korea. These studies covered a total of 6,566 rectal cancer patients with ypT0-2N0 after NCRT, of which 3,932 were ypT1-2N0.…”

Section: Basic Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Heterogeneity analysis revealed a moderate level of heterogeneity in the meta-analysis (I 2 = 49%, P=0.02). Furthermore, subgroup analysis was performed on 8 studies (20, 22,31,34,35,37,38,40) reporting the 5-year OS of ypT1-2N0 rectal cancer patients. The subgroup analysis indicated that ypT1-2N0 rectal cancer was able to benefit from ACT (OR=1.89, 95% CI: 1.13-3.19, P= 0.003).…”

Section: Overall Survivalmentioning

confidence: 99%

“…In the context of rectal cancer with good pathological response (ypT0-2N0), the need for ACT remains uncertain. Several studies have indicated that ACT does not have a significant impact on oncological outcomes for rectal cancer patients with good pathological response (18,22,23,34). For instance, the I-CNR-RT trial found that patients who achieved downstaging (ypT0-2N0) had better OS and lower rates of local and distant metastasis, but did not derive any benefit from ACT (23).…”

Section: B Amentioning

confidence: 99%

“…A phase III randomized controlled trial revealed that postoperative chemotherapy significantly enhanced OS in rectal cancer patients with ypT0-2, but there was no evidence to suggest that ACT was beneficial for survival in ypT3-4 stage rectal cancer (21). It should be noted that not all patients with ypT0-2N0 rectal cancer may benefit from ACT (22,23). Therefore, we conducted this meta-analysis to explore the impact of ACT on the oncological outcomes of rectal cancer patients who demonstrated a good response (ypT0-2N0) to NCRT.…”

Section: Introductionmentioning

confidence: 99%

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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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