Ann Surg Treat Res.  2020 Aug;99(2):97-109. 10.4174/astr.2020.99.2.97.

Oncologic effects of adjuvant chemotherapy in patientswith ypT0–2N0 rectal cancer after neoadjuvantchemoradiotherapy and curative surgery: a meta-analysis

• Ha GW
• Lee MR

• KMID: 2504822
• DOI: http://doi.org/10.4174/astr.2020.99.2.97

Abstract

Purpose
The role of adjuvant chemotherapy for patients with ypT0–2N0 rectal cancer following neoadjuvantchemoradiotherapy (nCRT) and curative surgery is uncertain. We performed a meta-analysis using selected studies tocompare 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 wascalculated 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 4,747patients for the meta-analysis. In analysis of patients with ypT0N0 rectal cancer, adjuvant chemotherapy had no significanteffect 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 nCRTand radical surgery. Routine use of adjuvant chemotherapy for those patients may be avoided.

Keyword

Adjuvant chemotherapy; Chemoradiotherapy; Prognosis; Rectal neoplasms

Figure

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  Fig. 1 PRISMA flow diagram.

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  Fig. 2 Meta-analysis of the effects of adjuvant chemotherapy. (A) On overall survival (OS) in patients with ypT0–2N0 rectal cancer after neoadjuvant chemoradiotherapy (nCRT) and radical surgery. (B) On disease-free survival (DFS) in patients with ypT0–2N0 rectal cancer after nCRT and radical surgery. (C) On local and distant recurrence in patients with ypT0–2N0 rectal cancer after nCRT and radical surgery. OR, odds ratio; CI, confidence interval; df, degree of freedom.

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  Fig. 3 Subgroup analysis of oncologic effects of adjuvant chemotherapy in patients with ypT0N0 rectal cancer. OR, odds ratio; CI, confidence interval; df, degree of freedom; OS, overall survival; DFS, disease-free survival.

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  Fig. 4 Subgroup analysis of oncologic effects of adjuvant chemotherapy in patients with ypT1–2N0 rectal cancer. OR, odds ratio; CI, confidence interval; df, degree of freedom; OS, overall survival; DFS, disease-free survival.

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  Fig. 5 The funnel plot for analysis of overall survival (OS), disease-free survival (DFS), and local recurrence in patients with ypT0–2N0 rectal cancer. SE, standard error; OR, odds ratio.

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