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Cancers 2019, 11(4), 550; https://doi.org/10.3390/cancers11040550

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

1
Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy
2
Oncology Unit, Fondazione Poliambulanza, 25124 Brescia, Italy
3
Oncology Unit, Casa di Cura Igea, 20129 Milano, Italy
4
Oncology Unit, ASST Cremona, 26100 Cremona, Italy
5
Surgical Oncology Unit, ASST of Bergamo, 24100 Bergamo Ovest, Italy
*
Author to whom correspondence should be addressed.
Received: 2 April 2019 / Revised: 13 April 2019 / Accepted: 15 April 2019 / Published: 17 April 2019
PDF [550 KB, uploaded 17 April 2019]

Abstract

(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; p <0.001). Similarly, for gastric cancer, delaying adjuvant CT was associated with inferior overall survival (HR = 1.2, 95% CI 1.04–1.38; p = 0.01). Conversely, the benefit of earlier CT was not evident in pancreatic cancer (HR = 1, 95% CI 1–1.01; p = 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.
Keywords: colorectal cancer; gastric cancer; pancreatic cancer; adjuvant chemotherapy; timing; meta-analysis. colorectal cancer; gastric cancer; pancreatic cancer; adjuvant chemotherapy; timing; meta-analysis.
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Petrelli, F.; Zaniboni, A.; Ghidini, A.; Ghidini, M.; Turati, L.; Pizzo, C.; Ratti, M.; Libertini, M.; Tomasello , G. Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis. Cancers 2019, 11, 550.

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