Comparison of the efficacy of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: meta-analysis of randomized controlled trials

作者：Dexing Zeng, Ruonan Liu, Xian-Kun Ren, Peng Zhang, Linghan Tang, Ling Tan, Rehman Zia Ur, Mao-Ru Zhao, Peng Guo, Pan Zhang, Jun Du, Xian Qin, Shi-Yan Wan, Lu-Qian Deng, Yajun Luo, Haohuan Li, Jiangwei Xiao · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000002262 · 被引用次数：8 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal and Anal Carcinomas、Esophageal Cancer Research and Treatment

BACKGROUND: Preoperative neoadjuvant chemoradiotherapy (nCRT) is considered to be the standard treatment strategy for locally advanced rectal cancer (LARC); however, the risk of adverse events and postoperative recurrence remains significant. This study aimed to evaluate the non-inferiority of neoadjuvant chemotherapy (nCT) compared with nCRT in patients with LARC and to assess the possibility of eliminating radiotherapy on the basis of guaranteed efficacy. MATERIALS AND METHODS: We searched the PubMed, Embase, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing the efficacy of nCRT and nCT for LARC. The study protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO). RESULTS: A total of 2706 patients from seven studies were included in the meta-analysis. There was no significant difference in overall survival (OS) or disease-free survival (DFS) between the nCT and nCRT groups. This study demonstrated a lower rate of infection (OR = 0.53, 95% CI = 0.34-0.82; P = 0.005), anastomotic leak (OR = 0.55, 95% CI = 0.34-0.87; P = 0.01), tumor regression grade (TRG) 0-1 (OR = 0.50, 95% CI = 0.36-0.69; P < 0.0001), preventive diverting ileostomy (OR = 0.41, 95% CI = 0.17-1.02; P = 0.05), and leukopenia (OR = 0.50, 95% CI = 0.25-1.01; P = 0.05) in the nCT group. However, there was no significant difference in the other toxic events, such as intestinal obstruction, urinary complications, diarrhea, and surgical or pathologi...