Survival and safety after neoadjuvant chemotherapy or upfront surgery for locally advanced colon cancer: meta-analysis

Background: Neoadjuvant chemotherapy is increasingly used to treat locally advanced (T3-4 Nx-2 M0) colon cancer due to its potential advantages over the standard approach of upfront surgery. The primary objective of this systematic review and meta-analysis was to analyse data from comparative studie...

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Detalles Bibliográficos
Autores: Aliseda-Jover, D. (Daniel)|||/items/bfa542c5-12cf-4850-959a-d81305d560cd, Arredondo-Chaves, J. (Jorge)|||/items/1b0d3aba-50e4-417d-bd5d-0063cb6f15d5, Sánchez-Justicia, C. (Carlos)|||/items/f37663b2-feec-4320-bd0f-9620eaa916ac, Alvarellos-Pérez, A. (Alicia)|||/items/8b3ddf93-ad0c-4baf-a942-fcc34580a635, Matos-García, I. (Ignacio)|||/items/245b22bb-7d6c-4f39-b623-c35eb8efcf30, Rotellar-Sastre, F. (Fernando)|||/items/833cb788-f4b9-404d-a18b-ae1c84369b51, Baixauli-Fons, J. (Jorge)|||/items/c863985d-f450-4807-a4fe-56d26f6e8dfa, Rodríguez-Ubreva, J. (Javier)|||/items/ebc19c3e-2fdd-4284-93d1-29e071a5ffa1, Pastor-Idoate, C. (Carlos)|||/items/db004f1c-c96b-428d-b929-408dda2c568d
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad de Navarra
Repositorio:Dadun. Depósito Académico Digital de la Universidad de Navarra
Idioma:inglés
OAI Identifier:oai:dadun.unav.edu:10171/69410
Acceso en línea:https://hdl.handle.net/10171/69410
Access Level:acceso abierto
Palabra clave:Surgical complications
Colorectal cancer
Surgical procedures
Operative
Survival rate
Mortality
Colon
Cancer
Chemotherapy
Neoadjuvant
Surgical mortality
General Surgery
Materias Investigacion::Ciencias de la Salud::Cirugía
Materias Investigacion::Ciencias de la Salud
Descripción
Sumario:Background: Neoadjuvant chemotherapy is increasingly used to treat locally advanced (T3-4 Nx-2 M0) colon cancer due to its potential advantages over the standard approach of upfront surgery. The primary objective of this systematic review and meta-analysis was to analyse data from comparative studies to assess the impact of neoadjuvant chemotherapy on oncological outcomes. Methods: A systematic review was conducted by searching the MEDLINE and Scopus databases. The search encompassed RCTs, propensity score-matched studies, and controlled prospective studies published up to 1 April 2023. As a primary objective, overall survival and disease-free survival were compared. As a secondary objective, perioperative morbidity, mortality, and complete resection were compared using the DerSimonian and Laird models. Results: A total of seven studies comprising a total of 2120 patients were included. Neoadjuvant chemotherapy was associated with a reduction in the hazard of recurrence (HR 0.73, 95% c.i. 0.59 to 0.90; P = 0.003) and death (HR 0.67, 95% c.i. 0.54 to 0.83; P < 0.001) compared with upfront surgery. Additionally, neoadjuvant chemotherapy was significantly associated with higher 5-year overall survival (79.9% versus 72.6%; P < 0.001) and disease-free survival (73.1% versus 64.5%; P = 0.028) rates. No significant differences were observed in perioperative mortality (OR 0.97, 95% c.i. 0.28 to 3.33), overall complications (OR 0.95, 95% c.i. 0.77 to 1.16), or anastomotic leakage/intra-abdominal abscess (OR 0.88, 95% c.i. 0.60 to 1.29). However, neoadjuvant chemotherapy was associated with a lower risk of incomplete resection (OR 0.70, 95% c.i. 0.49 to 0.99). Conclusion: Neoadjuvant chemotherapy is associated with a reduced hazard of recurrence and death, as well as improved overall survival and disease-free survival rates, compared with upfront surgery in patients with locally advanced colon cancer.

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