Prognostic Significance of Partial Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer: A Meta-analysis

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Abstract

BACKGROUND:

Complete tumor regression after preoperative chemoradiotherapy for rectal cancer has been associated with better disease-free and overall survival. The survival experience for patients with partial tumor regression is less clear.

OBJECTIVE:

The aim of this meta-analysis was to evaluate the prognostic significance of partial response after preoperative chemotherapy on disease-free survival in rectal cancer patients.

DATA SOURCES:

Relevant studies were identified by a search of MEDLINE and EMBASE databases with no restrictions to October 31, 2012.

STUDY SELECTION:

We included long-course radiotherapy that reported the association between degree of tumor regression and disease-free survival of rectal cancer.

INTERVENTIONS:

Direct, indirect, and graph methods were used to extract HRs.

MAIN OUTCOME MEASURES:

Study-specific HRs on the disease-free survival were pooled using a random-effects model. Eleven articles in total were selected. Analysis was performed first among the 6 studies that separated partial response from the complete response and later among all 11 of the studies.

RESULTS:

Pooled HR was 0.49 (95% CI, 0.28–0.85) for the 6 studies that compared partial response with poor response. It was 0.41 (95% CI, 0.25–0.67) when all 11 of the studies were analyzed together.

LIMITATIONS:

The studies were limited by not being prospective, randomized trials, and the tumor regression grades were not uniform.

CONCLUSIONS:

Partial tumor response is associated with a 50% improvement in disease-free survival and should be considered as a favorable prognostic factor.

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