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Current evidence regarding the role of adjuvant chemotherapy in rectal cancer patients with pathologic complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis

Abstract

Purpose

The aim of this meta-analysis was to investigate the role of adjuvant chemotherapy (AC) in rectal cancer patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) and curative resection.

Methods

This study was completed in accordance to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened for eligible articles. The level of evidence (LoE) was assessed using the GRADE methodology.

Results

Overall, 23 non-randomized studies and 17,406 patients were included in the present meta-analysis. Pooled comparisons confirmed that AC improved overall survival (HR: 0.68, p=0.0003), but not disease-free (p=0.22) and recurrence-free survival (p=0.39). However, the LoE for all outcomes was characterized as “very low,” due to the absence of RCTs.

Conclusions

Considering the study limitations and the lack of randomized studies, further high-quality RCTs are required to confirm the findings of our study.

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Data availability

Data available on request from the authors

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Contributions

Conception and design of the study: TZOVARAS, BALOYIANNIS

Acquisition of data: PERIVOLIOTIS, VEDERAKI

Drafting the article: PERIVOLIOTIS, BALOYIANNIS

Critical revision: KOUKOULIS, SYMEONIDIS

Final approval: TZOVARAS, BALOYIANNIS

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Correspondence to Konstantinos Perivoliotis.

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Appendix

Appendix

Fig. 1
figure1

Study flow diagram

Fig. 2
figure2

Hazard ratio of overall survival

Fig. 3
figure3

Sensitivity analysis of the primary outcome

Table 1 Study characteristics
Table 2 Summary of findings table

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Cite this article

Baloyiannis, I., Perivoliotis, K., Vederaki, S. et al. Current evidence regarding the role of adjuvant chemotherapy in rectal cancer patients with pathologic complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis. Int J Colorectal Dis 36, 1395–1406 (2021). https://doi.org/10.1007/s00384-021-03915-9

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Keywords

  • Adjuvant
  • Rectal
  • Neoadjuvant
  • Pathologic
  • Complete