Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients with Resectable Rectal Cancer: a Meta-Analysis

Abstract

Background: The impact of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer is controversial. This study aimed to explore the effect of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer. Methods: Four major databases (PubMed, Web of Science, Embase, Cochrane library) were searched to find relevant articles published between January 2000 and July 2020. The main outcome indicators were the 5-year overall survival (OS) and disease-free survival (DFS). Results: Compared with upfront surgery, our meta-analysis showed that 5-year OS (HR: 0.84, 95% Cl: 0.78-0.91) and DFS (HR: 0.91, 95% Cl: 0.87-0.95) were prolonged for patients with resectable rectal cancer after receiving neoadjuvant therapy. The results of subgroup analysis suggested that both neoadjuvant short-course radiotherapy (SCRT) and neoadjuvant chemo-radiotherapy (CRT) could improve the 5-year OS and DFS. The 5-year OS and DFS of patients with stage Ⅱ-Ⅲ rectal cancer increased significantly and the improvement of 5-year OS and DFS could also be observed in mid/low rectal cancer.Conclusion: Neoadjuvant therapy could improve the long-term survival of patients with mid/low rectal cancer in stage Ⅱ-Ⅲ. For the treatment, neoadjuvant SCRT and neoadjuvant CRT were recommended.