背景:全新辅助治疗(TNT)是一种新辅助治疗和化疗相结合的新策略,可增强肿瘤缩小和全身控制。其有效性仍在辩论中。
目的:本研究对随机对照试验(RCT)进行荟萃分析,以评估TNT的影响,并为直肠癌治疗决策提供高质量的证据。
方法:我们搜索了中国国家知识基础设施,VIP数据库,万方数据库,中国生物医学文献数据库,PubMed数据库,Embase数据库,和Cochrane图书馆用于比较TNT和新辅助放化疗(CRT)在局部晚期直肠癌中的RCT。纳入的试验根据纳入和排除标准进行筛选和质量评估。采用RevMan5.3软件进行Meta分析。
结果:在14篇文章中总共报告了11项RCT,TNT组1624例,CRT组1541例。Meta分析结果显示,与CRT组相比,TNT组有较高的病理完全缓解率(RR=1.65,95%CI[1.40,1.94],P<0.00001),较高的T0降级率(RR=1.51,95%CI[1.29,1.77],P<0.00001),较高的3年总生存率(HR=0.81,95%CI[0.67,0.98],P=0.03),和更高的3年无病生存率(HR=0.82,95%CI[0.70,0.95],P=0.008)。然而,两组的R0切除率差异无统计学意义(RR=1.02,95%CI[0.99,1.05],P=0.14),括约肌保存率(RR=0.94,95%CI[0.88,1.01],P=0.12),吻合口漏发生率(RR=1.42,95%CI[0.85,2.38],P=0.18),和3级或更高级别不良事件(RR=1.21,95%CI[0.95,1.54],P=0.13)。
结论:在局部晚期直肠癌的治疗中,与新辅助CRT相比,TNT具有更大的生存益处,并且不会显着增加不良事件的发生率。然而,仍需要进一步的数据和长期结果研究.
BACKGROUND: Total neoadjuvant therapy (TNT) is a new strategy combining neoadjuvant therapy and chemotherapy to enhance tumor shrinkage and systemic control. Its effectiveness remains debated.
OBJECTIVE: This study conducts a meta-analysis of randomized controlled trials (RCTs) to assess TNTs impact and provide high-quality evidence for rectal cancer treatment decisions.
METHODS: We searched China National Knowledge Infrastructure, VIP Database, Wanfang Database, China biomedical literature database, PubMed database, Embase database, and The Cochrane Library for RCTs comparing TNT with neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer. The included trials were screened and assessed for quality based on inclusion and exclusion criteria, and meta-analysis was performed using RevMan 5.3 software.
RESULTS: A total of 11 RCTs reported in 14 articles, with 1,624 cases in the TNT group and 1,541 cases in the CRT group. The results of the meta-analysis showed that compared with the CRT group, the TNT group had a higher pathological complete response rate (risk ratio [RR] = 1.65, 95% confidence interval [CI]: [1.40, 1.94], p < 0.00001), higher T0 downstaging rate (RR = 1.51, 95% CI: [1.29, 1.77], p < 0.00001), higher 3-year overall survival (hazard ratio [HR] = 0.81, 95% CI: [0.67, 0.98], p = 0.03), and higher 3-year disease-free survival (HR = 0.82, 95% CI: [0.70, 0.95], p = 0.008). However, there was no statistically significant difference between the two groups in terms of R0 resection rate (RR = 1.02, 95% CI: [0.99, 1.05], p = 0.14), sphincter preservation rate (RR = 0.94, 95% CI: [0.88, 1.01], p = 0.12), anastomotic leakage rate (RR = 1.42, 95% CI: [0.85, 2.38], p = 0.18), and grade 3 or higher adverse events (RR = 1.21, 95% CI: [0.95, 1.54], p = 0.13).
CONCLUSIONS: In the treatment of locally advanced rectal cancer, TNT offers greater survival benefits compared to neoadjuvant CRT and does not significantly increase the incidence of adverse events. However, further data and studies with long-term outcomes are still required.