Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis
Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis
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DOI：
10.1016/j.ejca.2010.01.020
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发表时间：
2010-04-01
影响因子：
8.4
通讯作者：
Uzzan, Bernard
中科院分区：
文献类型：
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作者：
Des Guetz, Gaetan;Nicolas, Patrick;Uzzan, Bernard
背景：在III期结直肠癌（CRC）中，辅助化疗（CT）通常在治愈性手术后两个月内进行。延迟开始CT是否会影响生存率仍然存在争议。材料和方法：我们对所有已发表的研究（全文或摘要）进行了荟萃分析（MA），比较延迟CT与标准护理。研究通过PubMed查询（关键词：CRC、辅助治疗、CT延迟）、综述（Chau et al., 2006）、交叉核对ASCO、ASCO GI和WCGI年会论文集的参考文献和摘要获得。我们选择了8周的截止延迟。根据记录的事件（死亡、复发）计算风险比（rr）。我们使用EasyMA软件（固定效应模型）。结果：纳入14项研究（包括4篇摘要），共纳入17,645例患者，其中男性5952例，女性5151例，平均年龄70岁。其中，3项研究无法进行统计分析，3项研究使用了另一个截止日期（4,5或6周），剩下8项研究用于主要MA（13,158例患者，男性3932例，女性3644例，缺失数据5942例；结肠癌5576例，直肠癌6677例，缺失数据1265例）。延迟CT超过8周与更差的总生存期（OS）相关（RR: 1.20； 95%可信区间（CI） 1.15-1.26）。在包括所有研究的MA中，无论其截止日期如何，更长的延迟同样与更差的OS相关，但与更差的无复发生存（RFS）无关（5项研究）。结论：术后8周内应开始辅助化疗。术后延迟开始辅助CT超过8周显著降低OS，但不降低RFS。这种差异可能是由于与癌症没有直接关系的因素（术后并发症、社会地位）或对死亡的更准确的评估。(C) 2010 Elsevier Ltd.版权所有。
Background: In stage III colorectal cancer (CRC), adjuvant chemotherapy (CT) is usually prescribed within two months after curative surgery. Whether or not delaying initiation of CT affects survival is still debated.Material and methods: We performed a meta-analysis (MA) of all published studies (full papers or abstracts) comparing delayed CT with standard care. Studies were obtained from a PubMed query (keywords: CRC, adjuvant treatment, delay of CT), a review (Chau et al., 2006), cross-checking references and abstracts from the proceedings of ASCO, ASCO GI and WCGI annual meetings. We chose a cutoff delay of 8 weeks. Risk Ratios (RRs) were calculated from the recorded events (deaths, relapses). We used EasyMA software (fixed-effect model).Results: Fourteen studies (including four abstracts) were identified (17,645 patients; 5952 males, 5151 females, mean age 70 years). Of these, three could not be statistically analysed and three used another cutoff (4, 5 or 6 weeks), leaving 8 studies for main MA (13,158 patients; 3932 males, 3644 females, 5942 missing data; 5576 colon cancers, 6677 rectal, 1265 missing data). Delaying CT more than 8 weeks was associated to worse Overall Survival (OS) (RR: 1.20; 95% Confidence Interval (CI) 1.15-1.26). In the MA including all studies whatever their cutoff, longer delay was similarly associated to a worse OS but not a worse Relapse-Free Survival (RFS) (five studies).Conclusion: Adjuvant chemotherapy should be started within 8 weeks after surgery. Delaying the initiation of adjuvant CT for more than 8 weeks after surgery significantly decreased OS but not RFS. This discrepancy might be due to factors not directly related to cancer (post-operative complications, social status) or to a more accurate appraisal of death. (C) 2010 Elsevier Ltd. All rights reserved.