Neoadjuvant chemotherapy versus surgery plus adjuvant chemotherapy for locally advanced colon cancer: A meta-analysis of randomized controlled trials.

person Barbara Klyslie Kato Municipal University of São Caetano do Sul, Sao Caetano Do Sul, São Paulo, Brazil info_outline Barbara Klyslie Kato, Bernardo Fontel Pompeu, Lucas Monteiro Delgado, Fernanda Bellotti Formiga, Daniele Evaristo Vieira Alves

Authors person Barbara Klyslie Kato Municipal University of São Caetano do Sul, Sao Caetano Do Sul, São Paulo, Brazil info_outline Barbara Klyslie Kato, Bernardo Fontel Pompeu, Lucas Monteiro Delgado, Fernanda Bellotti Formiga, Daniele Evaristo Vieira Alves Organizations Municipal University of São Caetano do Sul, Sao Caetano Do Sul, São Paulo, Brazil, Hospital Heliópolis, São Paulo, Brazil, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, IAMSPE - SP, São Paulo, Brazil Abstract Disclosures Research Funding No funding sources reported Background: The primary treatment for colon tumors is surgical resection, but the use of neoadjuvant chemotherapy (NAC) in managing locally advanced cases remains a subject of ongoing debate. We conducted a thorough meta-analysis, including randomized clinical trials (RCTs), to assess the oncological safety of neoadjuvant chemotherapy (NAC) in colorectal tumor patients. Methods: We systematically searched in PubMed, Scopus, Google Academic and Cochrane Library in January 2024 for studies that directly compared NAC versus surgery in patients with T3-4, N0-2, M0 colorectal cancer. We assessed overall survival (OS) and disease-free survival (DFS). We calculated odds ratios (ORs) and hazard ratios (HRs) using generic inverse variance in Review Manger 5.4. Heterogeneity was assessed using I² statistics. Results: We included seven RCTs, involving 4,391 patients. Among them, 53.5% underwent NAC, with a median age of 61.41 years and an average follow-up of 62.35 months. The comprehensive analysis revealed no statistically significant differences in 3-year OS (OR: 1.20, 95% CI: 0.91 to 1.59, p = 0.20), more than 2 years DFS (OR: 0.88, 95% CI: 0.37 to 2.13, p = 0.78) and five-year DFS (OR: 1.09, 95% CI: 0.83 to 1.43, p = 0.55). Employing a time-to-effect modeling approach, there was no significant difference in OS (HR: 1.04, 95% CI: 0.63 to 1.70, p = 0.88) or DFS (HR: 0.86, 95% CI: 0.7 to 1.06, p = 0.16); (Table 1). Conclusions: Our systematic review and meta-analysis of seven RCTs showed that neoadjuvant chemotherapy compared with surgery followed by adjuvant chemotherapy had similar overall survival and disease-free-survival in patients with locally advanced colon cancer. The baseline disease-free survival (DFS) and overall survival (OS) presented as odds ratio and hazard ratio. 3 year-Overall Survival More Than 2-year Disease-free-survival 5-year Disease Free-survival 3 year-Overall Survival (HR) 5-year Disease-free-Survival (HR) No. of studies 7 6 5 6 3 NAC (n) 1612 1088 1074 NA NA NAC N 1958 1756 1416 NA NA S + AC (n) 1280 865 522 NA NA S + AC N 1612 1184 606 NA NA OR (95% CI) 1.20 [0.91,1.59] 0.88 [0.37-2.13] 1.09 [0.83-1.43] NA NA HR (95% CI) NA NA NA 1.04 [0.63,1.70] 0.86 [0.70-1.06] Legend: NAC: neoadjuvant chemotherapy; S+AC: surgery plus adjuvant chemotherapy; n: number of events; N: number of patients in the sample; OR: odds ratio; CI: confidence intervals; HR: hazard ratio; NA:Not Applicable.