Patient Selection for Adjuvant Chemotherapy in High-Risk Stage II Colon Cancer: A Systematic Review and Meta-Analysis
Patient Selection for Adjuvant Chemotherapy in High-Risk Stage II Colon Cancer: A Systematic Review and Meta-Analysis
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高危 II 期结肠癌辅助化疗患者的选择：系统评价和荟萃分析
DOI：
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发表时间：
2020
影响因子：
2.6
通讯作者：
徐惠绵
中科院分区：
文献类型：
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作者：
张超;徐惠绵
辅助化疗：高风险II期结肠癌（CC）患者建议接受辅助化疗（ACT）。然而，这些患者是否能从ACT中获益仍不清楚。这项荟萃分析旨在研究临床病理学参数，这些参数对于选择高危II期CC患者进行ACT治疗非常重要。方法：我们系统地检索了PubMed、科克伦图书馆和Embase中截至2018年9月13日发表的文章。我们根据风险比（HR）和95%置信区间（CI）分析了总生存期（OS）和无病生存期（DFS）。结果：共纳入23项队列研究和1项随机对照试验。总体分析显示，ACT改善了高危II期CC患者的OS（HR=0.64，95% CI=0.51-0.80，P<0.001）和DFS（HR=0.46，95% CI=0.28-0.76，P=0.002）。亚组分析显示ACT改善了局限性肠穿孔和肠梗阻以及pT 4病变患者的OS，改善了采样淋巴结<12个的患者的OS和DFS。然而，ACT对淋巴血管浸润、神经周围浸润或组织学分化差的患者的OS无显著影响。结论：我们的研究表明，并不是所有的高危因素（淋巴管浸润、神经周围浸润、低分化组织学）都能从ACT中获益。将来需要有选择地针对高危患者进行随机对照试验。
OBJECTIVES:.Patients with high-risk stage II colon cancer (CC) are recommended to undergo adjuvant chemotherapy (ACT). However, whether such patients can benefit from ACT remains unclear. This meta-analysis aimed to investigate the clinicopathologic parameters that are important for selecting patients for ACT in high-risk stage II CC...METHODS:.We systematically retrieved articles from PubMed, the Cochrane Library, and Embase that were published up to September 13, 2018. We analyzed overall survival (OS) and disease-free survival (DFS) based on hazard ratios (HRs) and 95% confidence intervals (CIs)...RESULTS:.A total of 23 cohort studies and 1 randomized controlled trial were included in our study. Overall analyses showed that ACT improved OS (HR=0.64, 95% CI=0.51-0.80, P<0.001) and DFS (HR=0.46, 95% CI=0.28-0.76, P=0.002) in patients with high-risk stage II CC. Subgroup analyses showed that ACT improved OS in patients with localized intestinal perforation and obstruction and pT4 lesions and improved OS and DFS in patients with <12 sampled lymph nodes. However, ACT had no significant effect on OS in patients with lymphovascular invasion, perineural invasion, or poorly differentiated histology...CONCLUSIONS:.Our study suggests that not all high-risk factors (lymphovascular invasion, perineural invasion, poorly differentiated histology) show a benefit from ACT. Randomized controlled trials selectively targeting high-risk patients will need to be conducted in the future.