Complete Pathologic Response after Combined Modality Treatment for Rectal Cancer and Long-Term Survival: A Meta-Analysis

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• 作者：Luigi Zorcolo MD (1)
  Alan S. Rosman MD ; FACP (2)
  Angelo Restivo MD (1)
  Michele Pisano MD (3)
  Giuseppe R. Nigri MD ; FACS (4)
  Alessandro Fancellu MD (5)
  Marcovalerio Melis MD ; FACS (6)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2012
• 出版时间：September 2012
• 年：2012
• 卷：19
• 期：9
• 页码：2822-2832
• 全文大小：377KB
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• 作者单位：Luigi Zorcolo MD (1)
  Alan S. Rosman MD, FACP (2)
  Angelo Restivo MD (1)
  Michele Pisano MD (3)
  Giuseppe R. Nigri MD, FACS (4)
  Alessandro Fancellu MD (5)
  Marcovalerio Melis MD, FACS (6)
  
  1. Department of Surgery, University of Cagliari, Cagliari, Italy
  2. Section of Gastroenterology and Medicine Program, Mount Sinai School of Medicine and Bronx VAMC, New York, NY, USA
  3. Department of Surgery, Ospedali Riuniti di Bergamo, Bergamo, Italy
  4. Department of Surgery, Sapienza University of Rome, Rome, Italy
  5. Department of Surgery, Institute of Clinica Chirurgica, University of Sassari, Sassari, Italy
  6. Division of Surgical Oncology, New York University School of Medicine and New York Harbour Healthcare System VAMC, New York, NY, USA
  

文摘

Background Complete pathologic response (CPR) after neoadjuvant chemoradiotherapy (combined modality treatment, CMT) for rectal cancer seems associated with improved survival compared to partial or no response (NPR). However, previous reports have been limited by small sample size and single-institution design. Methods A systematic literature review was conducted to detect studies comparing long-term results of patients with CPR and NPR after CMT for rectal cancer. Variables were pooled only if evaluated by 3 or more studies. Study end points included rates of CPR, local recurrence (LR), distant recurrence (DR), 5-year overall survival (OS), and disease-free survival (DFS). Results Twelve studies (1,913 patients) with rectal cancer treated with CMT were included. CPR was observed in 300 patients (15.6%). CPR and NPR patient groups were similar with respect to age, sex, tumor size, distance of tumor from the anus, and stage of disease before treatment. Median follow-up ranged from 23 to 46?months. CPR patients had lower rates of LR [0.7% vs. 2.6%; odds ratio (OR) 0.45, 95% confidence interval (CI) 0.22-.90, P?=?0.03], DR (5.3% vs. 24.1%; OR 0.15, 95% CI 0.07-.31, P?=?0.0001), and simultaneous LR?+?DR (0.7% vs. 4.8%; OR 0.32, 95% CI 0.13-.79, P?=?0.01). OS was 92.9% for CPR versus 73.4% for NPR (OR 3.6, 95% CI 1.84-.22, P?=?0.002), and DFS was 86.9% versus 63.9% (OR 3.53, 95% CI 1.62-.72, P?=?0.002). Conclusions CPR after CMT for rectal cancer is associated with improved local and distal control as well as better OS and DFS.