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Optimal time of initiating adjuvant chemotherapy for Ⅲ postoperative colorectal neoplama metaanalysis

  

  1. Department of  Gastrointestinal Surgery, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,  Wuhan 430014,  China
  • Online:2018-04-05 Published:2018-04-24
  • Contact: Corresponding author: Feng Yongdong, Email: ydfeng@tjh.tjmu.edu.cn

Abstract: Objective  To gain access to the suitable interval of postoperative adjuvant chemotherapy(PAC) for stage Ⅲ colorectal cancer patients by metaanalysis and identify the effects of postoperative complications on interval  as well.  Methods  Casecontrol studies assessing the interval time between curative resection surgery and first PAC for Ⅲ CRC patients  were identified from Cochrane Library, PubMed, Web of Science, China National Knowledge Internet(CNKI). Overall Survival(OR),  RelapseFree Survival(RFS),  as well as the associations between postoperative complications and interval were concluded and statistically analyzed by Forest Plot.Results  Eleven casecontrol studies which covered a total of 47 775 patients(26 499 males;21 276 females)were contained in this  metaanalysis.  We chose eight weeks for the cutoff,beyond which was related to worse OS(OR=1.75;95% CI=1.352.25,P<0.01). If a variety of cutoffs were included,longer delay was similarly associated to a worse OS(OR=1.55,95%CI=1.231.93,P=0.0001),  but not a worse RFS(P=0.10). Postoperative complications became a key point of the delays of PAC(OR=2.43,95%CI=1.194.96,P=0.01). Conclusion  The first PAC should be performed within eight weeks in patients with stage Ⅲ colorectal cancer. Delayed PAC results in poor OS, while RFS has no significant impact. Effective control of postoperative complications is a necessary factor to ensure PAC on schedule.

Key words: colorectal neoplasm;postoperative complications; adjuvant , chemoradiotherapy;prognosis