Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis
(1) Background: The optimal timing of adjuvant chemotherapy (CT) in gastrointestinal malignancies is still a matter of debate. For colorectal cancer, it is recommended to start post-operative treatment within eight weeks. The objective of this study was to assess the clinical effects of starting adj...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-04-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/11/4/550 |
| _version_ | 1797709815945887744 |
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| author | Fausto Petrelli Alberto Zaniboni Antonio Ghidini Michele Ghidini Luca Turati Claudio Pizzo Margherita Ratti Michela Libertini Gianluca Tomasello |
| author_facet | Fausto Petrelli Alberto Zaniboni Antonio Ghidini Michele Ghidini Luca Turati Claudio Pizzo Margherita Ratti Michela Libertini Gianluca Tomasello |
| author_sort | Fausto Petrelli |
| collection | DOAJ |
| description | (1) Background: The optimal timing of adjuvant chemotherapy (CT) in gastrointestinal malignancies is still a matter of debate. For colorectal cancer, it is recommended to start post-operative treatment within eight weeks. The objective of this study was to assess the clinical effects of starting adjuvant CT within or after 6–8 weeks post-surgery in colorectal, gastric, and pancreatic cancer. (2) Methods: MEDLINE, EMBASE, and the Cochrane Library were searched in December 2018. Publications comparing the outcomes of patients treated with adjuvant CT administered before (early) or after (delayed) 6–8 weeks post-surgery for colorectal, gastric, and pancreatic cancer were identified. The primary endpoint was overall survival (OS). (3) Results: Out of 8752 publications identified, 34 comparative studies assessing a total of 141,853 patients were included. Meta-analysis indicated a statistically significant increased risk of death with delayed CT (>6–8 weeks post-surgery) in colorectal cancer (hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.21–1.33; <i>p</i> <0.001). Similarly, for gastric cancer, delaying adjuvant CT was associated with inferior overall survival (HR = 1.2, 95% CI 1.04–1.38; <i>p</i> = 0.01). Conversely, the benefit of earlier CT was not evident in pancreatic cancer (HR = 1, 95% CI 1–1.01; <i>p</i> = 0.37). Conclusions: Starting adjuvant CT within 6–8 weeks post-surgery is associated with a significant survival benefit for colorectal and gastric cancer, but not for pancreatic cancer. |
| first_indexed | 2024-03-12T06:43:21Z |
| format | Article |
| id | doaj.art-839ab0eadf2c4e82879a62d8d45691e0 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-12T06:43:21Z |
| publishDate | 2019-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-839ab0eadf2c4e82879a62d8d45691e02023-09-03T00:50:23ZengMDPI AGCancers2072-66942019-04-0111455010.3390/cancers11040550cancers11040550Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-AnalysisFausto Petrelli0Alberto Zaniboni1Antonio Ghidini2Michele Ghidini3Luca Turati4Claudio Pizzo5Margherita Ratti6Michela Libertini7Gianluca Tomasello8Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyOncology Unit, Fondazione Poliambulanza, 25124 Brescia, ItalyOncology Unit, Casa di Cura Igea, 20129 Milano, ItalyOncology Unit, ASST Cremona, 26100 Cremona, ItalySurgical Oncology Unit, ASST of Bergamo, 24100 Bergamo Ovest, ItalyOncology Unit, ASST Cremona, 26100 Cremona, ItalyOncology Unit, ASST Cremona, 26100 Cremona, ItalyOncology Unit, Fondazione Poliambulanza, 25124 Brescia, ItalyOncology Unit, ASST Cremona, 26100 Cremona, Italy(1) Background: The optimal timing of adjuvant chemotherapy (CT) in gastrointestinal malignancies is still a matter of debate. For colorectal cancer, it is recommended to start post-operative treatment within eight weeks. The objective of this study was to assess the clinical effects of starting adjuvant CT within or after 6–8 weeks post-surgery in colorectal, gastric, and pancreatic cancer. (2) Methods: MEDLINE, EMBASE, and the Cochrane Library were searched in December 2018. Publications comparing the outcomes of patients treated with adjuvant CT administered before (early) or after (delayed) 6–8 weeks post-surgery for colorectal, gastric, and pancreatic cancer were identified. The primary endpoint was overall survival (OS). (3) Results: Out of 8752 publications identified, 34 comparative studies assessing a total of 141,853 patients were included. Meta-analysis indicated a statistically significant increased risk of death with delayed CT (>6–8 weeks post-surgery) in colorectal cancer (hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.21–1.33; <i>p</i> <0.001). Similarly, for gastric cancer, delaying adjuvant CT was associated with inferior overall survival (HR = 1.2, 95% CI 1.04–1.38; <i>p</i> = 0.01). Conversely, the benefit of earlier CT was not evident in pancreatic cancer (HR = 1, 95% CI 1–1.01; <i>p</i> = 0.37). Conclusions: Starting adjuvant CT within 6–8 weeks post-surgery is associated with a significant survival benefit for colorectal and gastric cancer, but not for pancreatic cancer.https://www.mdpi.com/2072-6694/11/4/550colorectal cancergastric cancerpancreatic canceradjuvant chemotherapytimingmeta-analysis |
| spellingShingle | Fausto Petrelli Alberto Zaniboni Antonio Ghidini Michele Ghidini Luca Turati Claudio Pizzo Margherita Ratti Michela Libertini Gianluca Tomasello Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis Cancers colorectal cancer gastric cancer pancreatic cancer adjuvant chemotherapy timing meta-analysis |
| title | Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis |
| title_full | Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis |
| title_fullStr | Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis |
| title_short | Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis |
| title_sort | timing of adjuvant chemotherapy and survival in colorectal gastric and pancreatic cancer a systematic review and meta analysis |
| topic | colorectal cancer gastric cancer pancreatic cancer adjuvant chemotherapy timing meta-analysis |
| url | https://www.mdpi.com/2072-6694/11/4/550 |
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