The Postoperative Outcome of Adjuvant Chemotherapy for Patients with Rectal Cancer:A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGHong-peng , MINGuang-tao ,  YAONan

Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China;

Corresponding author：

YAONan, Email: Pro-YaoNan@163.com

Keywords：

Rectal cancer; Adjuvant chemotherapy; Meta-analysis

DOI：

10.7507/1007-9424.20150178

Video：

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Objective To assess the effect of adjuvant chemotherapy for patients with rectal cancer. Methods The related randomized controlled trials comparing patients underwent radical surgery for rectal cancer with (adjuvant chemotherapy group) or without (surgery alone group) adjuvant chemotherapy, were retrieved from the databases such as PubMed, Cochrane Library, EMBAS, CBM, CNKI, WanFang, and VIP, then using RevMan 5.2 software to conduct the Meta-analysis. Results A total of 8 articles involving 3 654 patients were included. The results of Meta-analysis showed that:①for all patients with rectal cancer, the 2-(OR=1.28, 95% CI: 1.05-1.57, P=0.020), 3-(OR=1.28, 95% CI: 1.09-1.51, P=0.003), and 5-year (OR=1.21. 95% CI: 1.05-1.40, P=0.008) survival rates of adjuvant chemotherapy group were higher than those of surgery alone group, respectively.②For patients with rectal cancer ofⅡstaging, compared with surgery alone group, the 5-year survival rate was higher in adjuvant chemotherapy group (OR=1.39, 95% CI: 1.09-1.78, P=0.009), but 5-year recurrence rate was lower in adjuvant chemotherapy group (OR=0.65, 95% CI: 0.49-0.87, P=0.003).③For patients with rectal cancer ofⅢstaging, compared with surgery alone group, the 5-year recurrence rate was lower in adjuvant chemotherapy group (OR=0.40, 95% CI: 0.26-0.64, P=0.000 1), but there was no significant difference on the 5-year survival rate (OR=1.27, 95% CI: 1.00-1.61, P=0.050). Conclusion Compared with radical surgery, radical surgery combined with postoperative adjuvant chemotherapy can improve the survival and reduce the recurrence for patients with rectal cancer.

Citation： WANGHong-peng, MINGuang-tao, YAONan. The Postoperative Outcome of Adjuvant Chemotherapy for Patients with Rectal Cancer:A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(6): 692-699. doi: 10.7507/1007-9424.20150178 Copy

1.	郑荣寿, 张思维, 吴良有, 等.中国肿瘤登记地区2008年恶性肿瘤发病和死亡分析.中国肿瘤, 2012, 21(1):1-12.
2.	Li M, Gu J. Changing patterns of colorectal cancer in China over a period of 20 years. World J Gastroenterol, 2005, 11(30):4685-4688.
3.	林国乐, 邱辉忠.结直肠癌辅助化疗的新观念和新进展.癌症进展, 2005, 3(2):139-143.
4.	杨林.化疗在结直肠癌中的地位及应用.实用肿瘤杂志, 2013, 28(1):15-19.
5.	Grage TD, Metter GE, Cornell GN, et al. Adjuvant chemotherapy with 5-fluorouracil after surgical resection of colorectal carcinoma (COG protocol 7041). A preliminary report. Am J Surg, 1977, 133(1):59-66.
6.	Grage TB, Hill GJ, Cornell GN, et al. Adjuvant chemotherapy in large-bowel cancer:demonstration of effectiveness of single agent chemotherapy in a prospectively controlled, randomized trial. Recent Results Cancer Res, 1978, 68:222-230.
7.	Beets GL, Glimelius BL. Adjuvant chemotherapy for rectal cancer still controversial. Lancet Oncol, 2014, 15(2):130-131.
8.	Bachet JB, Rougier P, de Gramont A, et al. Rectal cancer and adjuvant chemotherapy:which conclusions?. Bull Cancer, 2010, 97(1):107-122.
9.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0. 2011-03. www.cochrane-handbook.org.2014.
10.	Glimelius B, Dahl O, Cedermark B, et al. Adjuvant chemotherapy in colorectal cancer:a joint analysis of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Acta Oncol, 2005, 44(8):904-912.
11.	Quasar Collaborative Group; Gray R, Barnwell J, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer:a randomised study. Lancet, 2007, 370(964):2020-2029.
12.	Hamaguchi T, Shirao K, Moriya Y, et al. Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC). Cancer Chemother Pharmacol, 2011, 67(3):587-596.
13.	Ito K, Yamaguchi A, Miura K, et al. Oral adjuvant chemotherapy with carmofur (HCFU) for colorectal cancer:five-year follow-up. Tokai HCFU Study Group-third study on colorectal cancer. J Surg Oncol, 1996, 63(2):107-111.
14.	Kato T, Ohashi Y, Nakazato H, et al. Efficacy of oral UFT as adjuvant chemotherapy to curative resection of colorectal cancer:multicenter prospective randomized trial. Langenbecks Arch Surg, 2002, 386(8):575-581.
15.	Kodaira S, Kikuchi K, Kunii Y, et al. Postoperative adjuvant chemotherapy with mitomycin C and UFT for curatively resected rectal cancer. Results from the Cooperative Project No.7 Group of the Japanese Foundation for Multidisciplinary Treatment of Cancer. Int J Clin Oncol, 1998, 3(6):357-364.
16.	Taal BG, Van Tinteren H, Zoetmulder FA, et al. Adjuvant 5FU plus levamisole in colonic or rectal cancer:improved survival in stageⅡandⅢ. Br J Cancer, 2001, 85(10):1437-1443.
17.	Watanabe M, Nishida O, Kunii Y, et al. Randomized controlled trial of the efficacy of adjuvant immunochemotherapy and adjuvant chemotherapy for colorectal cancer, using different combinations of the intracutaneous streptococcal preparation OK-432 and the oral pyrimidines 1-hexylcarbamoyl-5-fluorouracil and uracil/tegafur. Int J Clin Oncol, 2004, 9(2):98-106.
18.	Petersen SH, Harling H, Kirkeby LT, et al. Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev, 2012, 3:CD004078.
19.	Palta M, Czito BG, Willett CG. Colorectal cancer:adjuvant chemotherapy for rectal cancer-an unresolved issue. Nat Rev Clin Oncol, 2014, 11(4):182-184.
20.	Caricato M, Borzomati D, Ausania F, et al. Prognostic factors after surgery for locally recurrent rectal cancer:an overview. Eur J Surg Oncol, 2006, 32(2):126-132.
21.	Kahlert C, Gaitzsch E, Steinert G, et al. Expression analysis of aldehyde dehydrogenase 1A1 (ALDH1A1) in colon and rectal cancer in association with prognosis and response to chemotherapy. Ann Surg Oncol, 2012, 19(13):4193-4201.
22.	Desgrippes R, Bouvier V, Delafosse P, et al. Management of rectal cancer in France in a well-defined population. Eur J Gastroenterol Hepatol, 2014, 26(7):743-747.
23.	de Gramont A, Chibaudel B, Bachet JB, et al. From chemotherapy to targeted therapy in adjuvant treatment for stageⅢcolon cancer. Semin Oncol, 2011, 38(4):521-532.
24.	万相斌, 潘志忠, 陈功, 等. Dukes'B期结直肠癌术后辅助化疗的Meta分析.癌症, 2005, 24(5):600-604.
25.	Engstrom PF, Arnoletti JP, Benson AB 3rd, et al. NCCN Clinical Practice Guidelines in Oncology:rectal cancer. J Natl Compr Canc Netw, 2009, 7(8):838-881.
26.	André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stageⅡorⅢcolon cancer in the MOSAIC trial. J Clin Oncol, 2009, 27(19):3109-3116.
27.	Benson AB, Schrag D, Somerfield MR, et al. American society of clinical oncology recommendations on adjuvant chemotherapy for stageⅡcolon cancer. J Clin Oncol, 2004, 22(16):3408-3419.
28.	Lin HH, Chang YY, Lin JK, et al. The role of adjuvant chemotherapy in stageⅡcolorectal cancer patients. Int J Colorectal Dis, 2014, 29(10):1237-1243.

1. 郑荣寿, 张思维, 吴良有, 等.中国肿瘤登记地区2008年恶性肿瘤发病和死亡分析.中国肿瘤, 2012, 21(1):1-12.
2. Li M, Gu J. Changing patterns of colorectal cancer in China over a period of 20 years. World J Gastroenterol, 2005, 11(30):4685-4688.
3. 林国乐, 邱辉忠.结直肠癌辅助化疗的新观念和新进展.癌症进展, 2005, 3(2):139-143.
4. 杨林.化疗在结直肠癌中的地位及应用.实用肿瘤杂志, 2013, 28(1):15-19.
5. Grage TD, Metter GE, Cornell GN, et al. Adjuvant chemotherapy with 5-fluorouracil after surgical resection of colorectal carcinoma (COG protocol 7041). A preliminary report. Am J Surg, 1977, 133(1):59-66.
6. Grage TB, Hill GJ, Cornell GN, et al. Adjuvant chemotherapy in large-bowel cancer:demonstration of effectiveness of single agent chemotherapy in a prospectively controlled, randomized trial. Recent Results Cancer Res, 1978, 68:222-230.
7. Beets GL, Glimelius BL. Adjuvant chemotherapy for rectal cancer still controversial. Lancet Oncol, 2014, 15(2):130-131.
8. Bachet JB, Rougier P, de Gramont A, et al. Rectal cancer and adjuvant chemotherapy:which conclusions?. Bull Cancer, 2010, 97(1):107-122.
9. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0. 2011-03. www.cochrane-handbook.org.2014.
10. Glimelius B, Dahl O, Cedermark B, et al. Adjuvant chemotherapy in colorectal cancer:a joint analysis of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Acta Oncol, 2005, 44(8):904-912.
11. Quasar Collaborative Group; Gray R, Barnwell J, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer:a randomised study. Lancet, 2007, 370(964):2020-2029.
12. Hamaguchi T, Shirao K, Moriya Y, et al. Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC). Cancer Chemother Pharmacol, 2011, 67(3):587-596.
13. Ito K, Yamaguchi A, Miura K, et al. Oral adjuvant chemotherapy with carmofur (HCFU) for colorectal cancer:five-year follow-up. Tokai HCFU Study Group-third study on colorectal cancer. J Surg Oncol, 1996, 63(2):107-111.
14. Kato T, Ohashi Y, Nakazato H, et al. Efficacy of oral UFT as adjuvant chemotherapy to curative resection of colorectal cancer:multicenter prospective randomized trial. Langenbecks Arch Surg, 2002, 386(8):575-581.
15. Kodaira S, Kikuchi K, Kunii Y, et al. Postoperative adjuvant chemotherapy with mitomycin C and UFT for curatively resected rectal cancer. Results from the Cooperative Project No.7 Group of the Japanese Foundation for Multidisciplinary Treatment of Cancer. Int J Clin Oncol, 1998, 3(6):357-364.
16. Taal BG, Van Tinteren H, Zoetmulder FA, et al. Adjuvant 5FU plus levamisole in colonic or rectal cancer:improved survival in stageⅡandⅢ. Br J Cancer, 2001, 85(10):1437-1443.
17. Watanabe M, Nishida O, Kunii Y, et al. Randomized controlled trial of the efficacy of adjuvant immunochemotherapy and adjuvant chemotherapy for colorectal cancer, using different combinations of the intracutaneous streptococcal preparation OK-432 and the oral pyrimidines 1-hexylcarbamoyl-5-fluorouracil and uracil/tegafur. Int J Clin Oncol, 2004, 9(2):98-106.
18. Petersen SH, Harling H, Kirkeby LT, et al. Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev, 2012, 3:CD004078.
19. Palta M, Czito BG, Willett CG. Colorectal cancer:adjuvant chemotherapy for rectal cancer-an unresolved issue. Nat Rev Clin Oncol, 2014, 11(4):182-184.
20. Caricato M, Borzomati D, Ausania F, et al. Prognostic factors after surgery for locally recurrent rectal cancer:an overview. Eur J Surg Oncol, 2006, 32(2):126-132.
21. Kahlert C, Gaitzsch E, Steinert G, et al. Expression analysis of aldehyde dehydrogenase 1A1 (ALDH1A1) in colon and rectal cancer in association with prognosis and response to chemotherapy. Ann Surg Oncol, 2012, 19(13):4193-4201.
22. Desgrippes R, Bouvier V, Delafosse P, et al. Management of rectal cancer in France in a well-defined population. Eur J Gastroenterol Hepatol, 2014, 26(7):743-747.
23. de Gramont A, Chibaudel B, Bachet JB, et al. From chemotherapy to targeted therapy in adjuvant treatment for stageⅢcolon cancer. Semin Oncol, 2011, 38(4):521-532.
24. 万相斌, 潘志忠, 陈功, 等. Dukes'B期结直肠癌术后辅助化疗的Meta分析.癌症, 2005, 24(5):600-604.
25. Engstrom PF, Arnoletti JP, Benson AB 3rd, et al. NCCN Clinical Practice Guidelines in Oncology:rectal cancer. J Natl Compr Canc Netw, 2009, 7(8):838-881.
26. André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stageⅡorⅢcolon cancer in the MOSAIC trial. J Clin Oncol, 2009, 27(19):3109-3116.
27. Benson AB, Schrag D, Somerfield MR, et al. American society of clinical oncology recommendations on adjuvant chemotherapy for stageⅡcolon cancer. J Clin Oncol, 2004, 22(16):3408-3419.
28. Lin HH, Chang YY, Lin JK, et al. The role of adjuvant chemotherapy in stageⅡcolorectal cancer patients. Int J Colorectal Dis, 2014, 29(10):1237-1243.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Postoperative Outcome of Adjuvant Chemotherapy for Patients with Rectal Cancer:A Meta-Analysis

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