Towards personalized treatment of T2N0 rectal cancer: A systematic review of long-term oncological outcomes of neoadjuvant therapy followed by local excision.
T2 tumor
local excision
neoadjuvant therapy
organ preservation
rectal cancer
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
revised:
17
05
2022
received:
26
04
2022
accepted:
19
05
2022
pubmed:
26
5
2022
medline:
6
8
2022
entrez:
25
5
2022
Statut:
ppublish
Résumé
Total mesorectal excision (TME) remains the treatment of choice in T2N0 tumors. However, evidence suggest that one-size-fits-all approach is not always beneficial for this group of patients. The aim of this study is to synthesize data on long-term outcomes after neoadjuvant therapy (NAT) followed by local excision (LE) in T2N0 rectal cancer patients in the perspective of a rectal-preserving strategy. A systematic search of PubMed/MEDLINE, SCOPUS, and Web of Science databases was conducted until October 2021 to identify studies comparing LE after NAT and TME or reporting oncologic outcomes after conservative approach. A pooled analysis was conducted using a fixed-effect model in the case of non-significant heterogeneity (P > 0.1), and a random effect model (DerSimonian-Laird method) when significant heterogeneity was present (P < 0.1) CRD42022300344. Nine studies were included in the analysis. Three of them were comparative studies. The pooled 3-year DFS, 5-year DFS, 3-year OS, 5-year OS, local and distant recurrence rates were 92.8% (95% CI 81.6-99.5%), 91.3% (95% CI 88.3-94.3%), 96.1% (95% CI 90.5-100%), 72.6% (95% CI 57.5-87.7%), 4% (95% CI 18-63%), and 4.9% (95% CI 2-7.8%), respectively, in subjects treated with NAT followed by LE. No heterogeneity was found for all these analyses, except for the 5-year OS sub-analysis (I LE following neoadjuvant CRT may provide comparable survival benefit to radical surgery for patients with clinical stage T2N0 in selected patients although the evidence is still limited to provide solid recommendations. A personalized therapeutic approach taking into account tumor and patient-related factors should be considered.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Total mesorectal excision (TME) remains the treatment of choice in T2N0 tumors. However, evidence suggest that one-size-fits-all approach is not always beneficial for this group of patients. The aim of this study is to synthesize data on long-term outcomes after neoadjuvant therapy (NAT) followed by local excision (LE) in T2N0 rectal cancer patients in the perspective of a rectal-preserving strategy.
METHODS
METHODS
A systematic search of PubMed/MEDLINE, SCOPUS, and Web of Science databases was conducted until October 2021 to identify studies comparing LE after NAT and TME or reporting oncologic outcomes after conservative approach. A pooled analysis was conducted using a fixed-effect model in the case of non-significant heterogeneity (P > 0.1), and a random effect model (DerSimonian-Laird method) when significant heterogeneity was present (P < 0.1) CRD42022300344.
RESULTS
RESULTS
Nine studies were included in the analysis. Three of them were comparative studies. The pooled 3-year DFS, 5-year DFS, 3-year OS, 5-year OS, local and distant recurrence rates were 92.8% (95% CI 81.6-99.5%), 91.3% (95% CI 88.3-94.3%), 96.1% (95% CI 90.5-100%), 72.6% (95% CI 57.5-87.7%), 4% (95% CI 18-63%), and 4.9% (95% CI 2-7.8%), respectively, in subjects treated with NAT followed by LE. No heterogeneity was found for all these analyses, except for the 5-year OS sub-analysis (I
CONCLUSION
CONCLUSIONS
LE following neoadjuvant CRT may provide comparable survival benefit to radical surgery for patients with clinical stage T2N0 in selected patients although the evidence is still limited to provide solid recommendations. A personalized therapeutic approach taking into account tumor and patient-related factors should be considered.
Identifiants
pubmed: 35614027
doi: 10.1111/jgh.15898
pmc: PMC9545053
doi:
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1426-1433Informations de copyright
© 2022 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Br J Surg. 2007 Oct;94(10):1285-92
pubmed: 17661309
Tech Coloproctol. 2020 Jun;24(6):605-607
pubmed: 32107687
Br J Surg. 2013 Sep;100(10):1368-75
pubmed: 23939849
Am J Surg. 2013 Oct;206(4):482-7
pubmed: 23849272
Lancet Gastroenterol Hepatol. 2021 Feb;6(2):92-105
pubmed: 33308452
Ann Surg. 2021 Jul 02;:
pubmed: 34225302
Dis Colon Rectum. 2008 Aug;51(8):1185-91; discussion 1191-4
pubmed: 18536973
J Gastroenterol Hepatol. 2022 Aug;37(8):1426-1433
pubmed: 35614027
Int J Colorectal Dis. 2015 Jan;30(1):19-29
pubmed: 25367179
Dis Colon Rectum. 2016 Oct;59(10):984-97
pubmed: 27602930
Surgery. 2019 Jun;165(6):1193-1198
pubmed: 30904173
Dis Colon Rectum. 2017 Jun;60(6):586-594
pubmed: 28481852
Lancet. 2017 Jul 29;390(10093):469-479
pubmed: 28601342
Ann Surg. 2007 May;245(5):726-33
pubmed: 17457165
N Engl J Med. 2004 Oct 21;351(17):1731-40
pubmed: 15496622
J Clin Oncol. 2008 Sep 20;26(27):4466-72
pubmed: 18802159
Colorectal Dis. 2018 Aug;20(8):O215-O225
pubmed: 29897171
Dis Colon Rectum. 2017 Feb;60(2):228-239
pubmed: 28059920
Ann Surg. 2010 May;251(5):807-18
pubmed: 20395841
Cancer Res Treat. 2014 Jul;46(3):243-9
pubmed: 25038759
Lancet Oncol. 2015 Nov;16(15):1537-1546
pubmed: 26474521
Lancet. 2000 Sep 16;356(9234):968-74
pubmed: 11041397
J Clin Med. 2021 Feb 08;10(4):
pubmed: 33567516
Mucosal Immunol. 2011 Mar;4(2):239-44
pubmed: 20944558
ANZ J Surg. 2003 Sep;73(9):712-6
pubmed: 12956787
Ann Surg. 2005 Aug;242(2):212-23
pubmed: 16041212
Control Clin Trials. 1996 Feb;17(1):1-12
pubmed: 8721797
Surg Endosc. 2015 Apr;29(4):755-73
pubmed: 25609317
Ann Surg Oncol. 2019 Aug;26(8):2497-2506
pubmed: 31025228
Updates Surg. 2021 Apr;73(2):527-537
pubmed: 33586089
Eur J Surg Oncol. 2015 Dec;41(12):1562-4
pubmed: 26493223
Ann Surg. 2003 Aug;238(2):203-13
pubmed: 12894013
Lancet Gastroenterol Hepatol. 2020 May;5(5):465-474
pubmed: 32043980
Updates Surg. 2020 Mar;72(1):29-37
pubmed: 31621033
Dis Colon Rectum. 2014 Oct;57(10):1162-8
pubmed: 25203371
Colorectal Dis. 2016 Jan;18(1):59-66
pubmed: 26391723
Dis Colon Rectum. 2020 Sep;63(9):1191-1222
pubmed: 33216491
Ann Surg Oncol. 1999 Jul-Aug;6(5):433-41
pubmed: 10458680
Lancet Gastroenterol Hepatol. 2018 Dec;3(12):825-836
pubmed: 30318451
N Engl J Med. 2006 Sep 14;355(11):1114-23
pubmed: 16971718
Nat Rev Urol. 2011 Jan;8(1):51-7
pubmed: 21135876
Syst Rev. 2015 Jan 01;4:1
pubmed: 25554246
Br J Surg. 2012 Sep;99(9):1211-8
pubmed: 22864880
J Gastrointest Surg. 2017 Oct;21(10):1666-1674
pubmed: 28819913
Clin Transl Oncol. 2016 Jul;18(7):666-71
pubmed: 26497352
World J Gastroenterol. 2014 Jul 28;20(28):9556-63
pubmed: 25071352
N Engl J Med. 2001 Aug 30;345(9):638-46
pubmed: 11547717
Open Med (Wars). 2019 Sep 12;14:653-662
pubmed: 31565674
JAMA Surg. 2019 Jan 1;154(1):47-54
pubmed: 30304338
Radiat Oncol J. 2016 Sep;34(3):177-185
pubmed: 27730804
Ann Oncol. 2017 Jul 1;28(suppl_4):iv22-iv40
pubmed: 28881920
Clin Gastroenterol Hepatol. 2020 Nov;18(12):2752-2759.e2
pubmed: 31622737
Colorectal Dis. 2017 Jul;19 Suppl 1:37-66
pubmed: 28632307