DataSheet_1_The role of neoadjuvant chemotherapy in patients with locally advanced colon cancer: A systematic review and meta-analysis.docx

BackgroundControversy persists about neoadjuvant chemotherapy (NAC) within the field of locally advanced colon cancer (LACC). The purpose of this study was to assess the existing and latest literature with high quality to determine the role of NAC in various aspects.
MethodsA comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted from inception to April 2022. Review Manager 5.3 was applied for meta-analyses with a random-effects model whenever possible.
ResultsOverall, 8 studies were included in this systematic review and meta-analysis, comprising 4 randomized controlled trials (RCTs) and 4 retrospective studies involving 40,136 participants. The 3-year overall survival (OS) (HR: 0.90, 95% CI: 0.66-1.23, P = 0.51) and 5-year OS (HR: 0.89, 95% CI: 0.53-1.03, P = 0.53) were comparable between two groups. Mortality in 30 days was found less frequent in the NAC group (OR: 0.43, 95% CI: 0.20-0.91, P = 0.03), whereas no significant differences were detected concerning other perioperative complications, R0 resection, or adverse events. In terms of subgroup analyses for RCTs, less anastomotic leak (OR: 0.51, 95% CI: 0.31-0.86, P = 0.01) and higher R0 resection rate (OR: 2.35, 95% CI: 1.04-5.32, P = 0.04) were observed in the NAC group.
ConclusionsNAC is safe and feasible for patients with LACC, but no significant survival benefit could be demonstrated. The application of NAC still needs to be prudent until significant evidence supporting the oncological outcomes is presented.
Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier (CRD42022333306).

背景 局部晚期结肠癌（locally advanced colon cancer, LACC）领域中，新辅助化疗（neoadjuvant chemotherapy, NAC）的应用价值仍存在争议。本研究旨在对当前高质量的最新文献进行系统评估，以明确新辅助化疗在多维度中的作用。
方法 本研究检索了PubMed、Embase、Web of Science及Cochrane Library数据库自建库至2022年4月的相关文献。采用RevMan 5.3软件，尽可能使用随机效应模型进行Meta分析。
结果 本系统评价与Meta分析共纳入8项研究，包含4项随机对照试验（randomized controlled trials, RCT）及4项回顾性研究，共计纳入40136名受试者。两组患者的3年总生存期（overall survival, OS）（风险比HR=0.90，95%置信区间CI=0.66~1.23，P=0.51）与5年OS（HR=0.89，95%CI=0.53~1.03，P=0.53）均无显著差异。新辅助化疗组术后30天死亡率更低（比值比OR=0.43，95%CI=0.20~0.91，P=0.03），但在其余围手术期并发症、R0切除及不良事件方面未观察到显著差异。针对随机对照试验的亚组分析显示，新辅助化疗组吻合口漏发生率更低（OR=0.51，95%CI=0.31~0.86，P=0.01），且R0切除率更高（OR=2.35，95%CI=1.04~5.32，P=0.04）。
结论 新辅助化疗用于局部晚期结肠癌患者安全可行，但未证实其可带来显著的生存获益。在获得支持肿瘤学结局的确凿证据之前，新辅助化疗的临床应用仍需谨慎。
系统评价注册：https://www.crd.york.ac.uk/prospero，注册号为CRD42022333306。