Abstract
Objective: This study used model analysis to clarify the benefits and risks of postoperative adjuvant chemotherapy compared with surgery alone in patients with stage II/III colorectal cancer. Methods: Clinical trials involving patients with stage II/III colorectal cancer who underwent surgery alone or those who received post-surgical adjuvant chemotherapy were searched in the PubMed and embase databases. By establishing a survival model, the overall survival (OS) and disease-free survival (DFS) of patients who underwent surgery alone or postoperative adjuvant chemotherapy were quantitatively analyzed to compare the differences between the two. In addition, the incidence of grade 3/4 adverse reactions in the adjuvant chemotherapy group was analyzed using the random effects model in the single-arm meta-analysis. Results: A total of 34 studies containing 33,069 patients were included in the analysis. This study found that postoperative adjuvant chemotherapy can effectively improve the OS and DFS of patients with colorectal cancer. The median OS of the adjuvant chemotherapy group and the surgery-only group was 118.8 months (95% CI: 96.6, 146.6) and 74.6 months (95% CI: 57.8, 96.1) respectively; and median DFS was 86.3 months (95% CI: 67.6, 110.6) and 40.8 months (95% CI: 23.7, 69.6) in the adjuvant chemotherapy and surgery-only groups, respectively. Common grade 3/4 adverse reactions in the adjuvant chemotherapy group include diarrhea, stomatitis, leukopenia, and nausea or vomiting, with an incidence of approximately 3%–6%. Conclusion: Patients with mid-stage colorectal cancer can benefit significantly from postoperative adjuvant chemotherapy. This study provides the necessary quantitative information for decision-making regarding the benefits and risks of receiving adjuvant chemotherapy after resection in patients with colorectal cancer.
Highlights
Colorectal cancer is one of the most common gastrointestinal malignancies, with the fourth highest incidence of malignancies and the second highest cancer-related mortality worldwide (Center et al, 2009; Salehiniya et al, 2017)
The study included 34 publications that enrolled 33,069 patients, which consisted of 21 publications (23 treatment arms, sample size of 7,020) in the surgery-only group and 31 publications (48 treatment arms, sample size of 26,049) in the postoperative adjuvant chemotherapy group (Table 1)
A total of 18 publications reported the incidence of grade 3/4 adverse reactions, and the results showed that the incidence of grade 3/4 diarrhea, leukopenia, stomatitis, and nausea or vomiting in the postoperative adjuvant chemotherapy group was 6%, 3%, 4%, and 4%, respectively (Supplementary Figure S5 in Supplements)
Summary
Colorectal cancer is one of the most common gastrointestinal malignancies, with the fourth highest incidence of malignancies and the second highest cancer-related mortality worldwide (Center et al, 2009; Salehiniya et al, 2017). Patients with stage II colorectal cancer along with other high-risk factors and stage III progressive colorectal cancer should be treated with radical surgery following postoperative adjuvant chemotherapy, while those with advanced or recurrent colorectal cancer are recommended to undergo multidisciplinary evaluation to determine whether there is a chance of resection or radiotherapy, which should be followed by adjuvant chemotherapy (Benson et al, 2020; Benson et al, 2021). Whether patients with stage II/III disease benefit from adjuvant chemotherapy remains controversial, there is currently no such study for quantitatively evaluating the efficacy of adjuvant chemotherapy regimens after radical surgery for colorectal cancer patients, as recommended in the NCCN guidelines (Carvalho and Glynne-Jones, 2017)
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