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Abstract：
BACKGROUND: Locally advanced rectal cancer (LARC) typically involves neoadjuvant chemoradiotherapy (nCRT) followed by surgery (total mesorectal excision, TME). While achieving a complete pathological response (pCR) is a strong indicator of a positive prognosis, the specific benefits of adjuvant chemotherapy after pCR remain unclear. To address this knowledge gap, we conducted a systematic review and meta-analysis to assess the potential advantages of adjuvant therapy in patients who achieve pCR.
METHODS: In this study, we searched Medline, Embase, and Web of Science databases for relevant research. We focused on binary outcomes, analyzing them using odds ratios (ORs) with 95% confidence intervals (CIs). To account for potential variability between studies, all endpoints were analyzed with DerSimonian and Laird random-effects models. We assessed heterogeneity using the I2 statistic and employed the R statistical software (version 4.2.3) for all analyses.
RESULTS: Thirty-four studies, comprising 31,558 patients, were included. The outcomes demonstrated a significant difference favoring the AC group in terms of overall survival (OS) (HR 0.75; 95% CI 0.60-0.94; p = 0.015; I2 = 0%), and OS in 5 years (OR 1.65; 95% CI 1.21-2.24; p = 0.001; I2 = 39%). There was no significant difference between the groups for disease-free survival (DFS) (HR 0.94; 95% CI 0.76-1.17; p = 0.61; I2 = 17%), DFS in 5 years (OR 1.19; 95% CI 0.82-1.74; p = 0.36; I2 = 43%), recurrence-free survival (RFS) (HR 1.10; 95% CI 0.87-1.40; p = 0.39; I2 = 0%), and relapse-free survival (OR 1.08; 95% CI 0.78-1.51; p = 0.62; I2 = 0%).
CONCLUSIONS: This systematic review and meta-analysis found a significant difference in favor of the ACT group in terms of survival after pCR. Therefore, the administration of this treatment as adjuvant therapy should be encouraged in clinical practice.
METHODS: In this study, we searched Medline, Embase, and Web of Science databases for relevant research. We focused on binary outcomes, analyzing them using odds ratios (ORs) with 95% confidence intervals (CIs). To account for potential variability between studies, all endpoints were analyzed with DerSimonian and Laird random-effects models. We assessed heterogeneity using the I2 statistic and employed the R statistical software (version 4.2.3) for all analyses.
RESULTS: Thirty-four studies, comprising 31,558 patients, were included. The outcomes demonstrated a significant difference favoring the AC group in terms of overall survival (OS) (HR 0.75; 95% CI 0.60-0.94; p = 0.015; I2 = 0%), and OS in 5 years (OR 1.65; 95% CI 1.21-2.24; p = 0.001; I2 = 39%). There was no significant difference between the groups for disease-free survival (DFS) (HR 0.94; 95% CI 0.76-1.17; p = 0.61; I2 = 17%), DFS in 5 years (OR 1.19; 95% CI 0.82-1.74; p = 0.36; I2 = 43%), recurrence-free survival (RFS) (HR 1.10; 95% CI 0.87-1.40; p = 0.39; I2 = 0%), and relapse-free survival (OR 1.08; 95% CI 0.78-1.51; p = 0.62; I2 = 0%).
CONCLUSIONS: This systematic review and meta-analysis found a significant difference in favor of the ACT group in terms of survival after pCR. Therefore, the administration of this treatment as adjuvant therapy should be encouraged in clinical practice.
摘要：
背景：局部晚期直肠癌（LARC）通常涉及新辅助放化疗（nCRT），然后进行手术（全直肠系膜切除术，TME).虽然达到完全病理反应（pCR）是积极预后的有力指标，pCR后辅助化疗的具体获益尚不清楚.为了解决这个知识差距，我们进行了系统综述和荟萃分析,以评估辅助治疗在达到pCR的患者中的潜在优势.
方法：在本研究中，我们搜索了Medline,Embase,和WebofScience数据库进行相关研究。我们专注于二元结果，使用比值比(OR)和95%置信区间(CI)对它们进行分析。为了解释研究之间的潜在差异，所有终点均采用DerSimonian和Laird随机效应模型进行分析.我们使用I2统计量评估异质性，并使用R统计软件（4.2.3版）进行所有分析。
结果：34项研究，包括31,558名患者，包括在内。结果显示，就总生存期（OS）而言，AC组存在显着差异（HR0.75;95％CI0.60-0.94;p=0.015;I2=0％），5年和OS（OR1.65；95%CI1.21-2.24；p=0.001；I2=39%）。两组之间的无病生存率（DFS）没有显着差异（HR0.94;95％CI0.76-1.17;p=0.61;I2=17％），5年内DFS（OR1.19；95%CI0.82-1.74；p=0.36；I2=43%），无复发生存率（RFS）（HR1.10;95％CI0.87-1.40;p=0.39;I2=0％），无复发生存率(OR1.08;95%CI0.78-1.51;p=0.62;I2=0%)。
结论：本系统综述和荟萃分析发现，在pCR后的生存率方面，ACT组存在显著差异。因此,在临床实践中应鼓励将这种治疗作为辅助治疗.
方法：在本研究中，我们搜索了Medline,Embase,和WebofScience数据库进行相关研究。我们专注于二元结果，使用比值比(OR)和95%置信区间(CI)对它们进行分析。为了解释研究之间的潜在差异，所有终点均采用DerSimonian和Laird随机效应模型进行分析.我们使用I2统计量评估异质性，并使用R统计软件（4.2.3版）进行所有分析。
结果：34项研究，包括31,558名患者，包括在内。结果显示，就总生存期（OS）而言，AC组存在显着差异（HR0.75;95％CI0.60-0.94;p=0.015;I2=0％），5年和OS（OR1.65；95%CI1.21-2.24；p=0.001；I2=39%）。两组之间的无病生存率（DFS）没有显着差异（HR0.94;95％CI0.76-1.17;p=0.61;I2=17％），5年内DFS（OR1.19；95%CI0.82-1.74；p=0.36；I2=43%），无复发生存率（RFS）（HR1.10;95％CI0.87-1.40;p=0.39;I2=0％），无复发生存率(OR1.08;95%CI0.78-1.51;p=0.62;I2=0%)。
结论：本系统综述和荟萃分析发现，在pCR后的生存率方面，ACT组存在显著差异。因此,在临床实践中应鼓励将这种治疗作为辅助治疗.
