The optimal time of starting adjuvant chemotherapy after curative surgery in patients with colorectal cancer

• Published in: BMC cancer 2023-05, Vol.23 (1), p.422-422, Article 422
• Main Authors: Yang, Yuchong, Lu, Yao, Tan, Hui, Bai, Ming, Wang, Xia, Ge, Shaohua, Ning, Tao, Zhang, Le, Duan, Jingjing, Sun, Yansha, Liu, Rui, Li, Hongli, Ba, Yi, Deng, Ting
• Format: Article
• Language: English
• Subjects: Adjuvant chemotherapy; Adjuvant treatment; Adjuvants, Immunologic; Brachytherapy; Cancer; Cancer patients; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant; Cognition; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - surgery; Colorectal surgery; Diagnosis; Humans; Medical prognosis; Metastasis; Patient outcomes; Prognosis; Relapse; Sensitivity analysis; Software; Statistical analysis; Surgery; Survival; Time to chemotherapy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-023-10863-w

Postoperative adjuvant chemotherapy (AC) is now well-accepted as standard for high-risk stage II and stage III colorectal cancer (CRC) patients, however the optimal time to initiate AC remains elusive. A comprehensive literature search was performed using the PubMed and Embase databases. The Hazard ratio (HR) with the corresponding 95% confidence interval (CI) was used as an effect measure to evaluate primary endpoints. All analyses were conducted using Stata software version 12.0 with the Random-effects model. A total of 30 studies were included in our study. Upon comparison on overall survival (OS), we identified that delaying the initiation of AC for > 8 weeks after operation was significantly associated with poor OS (HR: 1.37; 95% CI: 1.27-1.48; P  8 weeks was not undermined by subgroup analysis based on region, tumor site, sample size and study quality. No obvious differences were observed in survival between AC within 5-8 weeks and ≤ 4 weeks (HR: 1.03; 95% CI: 0.96 -1.10; P = 0.46). Moreover, two studies both highlighted that the survival benefit of AC was still statistically significant when AC was applied 5-6 months after surgery compared with the non-chemotherapy group. Delaying the initiation of AC for > 8 weeks after surgery was significantly associated with poor OS. AC started within 8 weeks after surgery brought more benefits to CRC patients. There were no obvious differences in survival benefits between AC within 5-8 weeks and ≤ 4 weeks. Compared to patients not receiving AC after surgery, a delay of approximately 5-6 months was still useful to improve prognosis.