Meta-analysis of oxaliplatin-based versus fluorouracil-based neoadjuvant chemoradiotherapy and adjuvant chemotherapy for locally advanced rectal cancer

// Xing-Li Fu 3, * , Zheng Fang 2, * , Liang-Hui Shu 4, * , Guo-Qing Tao 1 , Jian-Qiang Wang 5 , Zhi-Lian Rui 6 , Yong-Jie Zhang 2 , Zhi-Qiang Tian 1 1 Department of General Surgery, Wuxi People's Hospital Affiliated Nanjing Medical University, Wuxi 214023, China 2 Department of Biliary Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China 3 Health Science Center, Jiangsu University, Zhenjiang, Jiangsu 212001, China 4 Department of Nephrology and Endocrinology, The 101st Hospital of Chinese PLA (Wuxi Taihu Hospital), Wuxi 214044, China 5 The Second People’s Hospital of Jintan District, Changzhou, Jiangsu 213200, China 6 The People’s Hospital of Liyang, Changzhou, Jiangsu 213300, China * These authors contributed equally to this work Correspondence to: Zhi-qiang Tian, email: zhiqiangtiann@163.com Yong-jie Zhang, email: 13951574216@163.com Keywords: rectal cancer, neoadjuvant chemoradiotherapy, adjuvant chemotherapy, oxaliplatin, meta-analyses Received: November 22, 2016      Accepted: February 22, 2017      Published: March 11, 2017 ABSTRACT A meta-analysis was conducted to compare oxaliplatin-based with fluorouracil-based neoadjuvant chemoradiotherapy and adjuvant chemotherapy for locally advanced rectal cancer. MEDLINE, EMBASE and CENTRAL were systematically searched for relevant randomized controlled trials (RCTs) until January 31 2017. Review Manager (version 5.3) was used to analyze the data. Dichotomous data were calculated by odds ratio (OR) with 95% confidence intervals (CI). A total of 8 RCTs with 6103 stage II or III rectal cancer patients were analyzed, including 2887 patients with oxaliplatin+fluorouracil regimen and 3216 patients with fluorouracil alone regimen. Compared with fluorouracil-based regimen group, oxaliplatin-based regimen group attained higher pathologic complete response (OR = 1.29, 95% CI: 1.12−1.49, P = 0.0005) and 3-year disease-free survival (OR = 1.15, 95% CI: 0.93−1.42, P = 0.21), but suffered greater toxicity (OR = 2.07, 95% CI: 1.52−2.83, P < 0.00001). Also, there were no significant differences between two regimens in sphincter-sparing surgery rates (OR = 0.94, 95% CI: 0.83−1.06, P = 0.33), 5-year disease-free survival (OR = 1.15, 95% CI: 0.93−1.42, P = 0.21) and overall survival (3-year, OR = 1.14, 95% CI: 0.98−1.34, P = 0.09; 5-year, OR = 1.06, 95% CI: 0.78−1.44, P = 0.70). In conclusion, the benefits of adding oxaliplatin to fluorouracil-based neoadjuvant chemoradiotherapy and adjuvant chemotherapy for locally advanced rectal cancer remains controversial, and cannot be considered a standard approach.