Comparison of 5-FU-based and Capecitabine-based Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Meta-analysis

作者：Zou, Xiang-cai; Wang, Qi-wen; Zhang, Ji-min^*

来源：Clinical Colorectal Cancer, 2017, 16(3): E123-E139.

DOI：10.1016/j.clcc.2017.01.009

• Capecitabine
• 5-fluorouracil
• Pathologic complete response
• Rectal cancer
• Tumor down-staging

This meta-analysis evaluated 10 studies that compared the efficacy and safety of continuous infusion 5-fluorouracil-based with those of oral capecitabine-based neoadjuvant chemoradiotherapy regimens for rectal cancer. There was no significant difference in the rate of tumor down-staging, pathologic complete response, or disease-free and overall survival between the 2 groups. Oral capecitabine is an attractive alternative to 5-fluorouracil-based chemoradiotherapy for rectal cancer. @@@ Introduction: The inconvenience of using infusion therapies resulted in the development of capecitabine (CA), an oral fluoropyrimidine. In this meta-analysis, we evaluated 10 studies that compared the efficacy and safety of an oral CA-based regimen with those of a continuous infusion 5-fluorouracil (5-FU) regimen for neoadjuvant chemoradiotherapy in patients with rectal cancer. Materials and Methods: The databases searched included Medline, Cochrane, EMBASE, and Google Scholar (until August 31, 2016). The primary outcome assessed was the rate of postoperative down-staging of the tumor and pathologic complete response. The secondary outcomes were diseasefree survival (DFS) and overall survival (OS). Results: This meta-analysis (5 retrospective studies, 3 prospective studies, and 2 randomized controlled trials [RCTs]) compared the efficacy of the 5-FU arm (n = 757) to that of the CA arm (n = 719). There was no significant difference in tumor down-staging rate between the 2 regimens (RCTs/prospective studies: odds ratio [OR], 0.88; 95% confidence interval [CI], 0.65-1.20; P = .416; retrospective studies: OR, 0.84; 95% CI, 0.50-1.44; P = .534). There was also no significant difference in pathologic complete response (RCTs/prospective studies: OR, 0.80; 95% CI, 0.52-1.23; P = .304; retrospective studies: OR, 0.73; 95% CI, 0.48-1.12; P = .149), or survival rates (3-year, 5-year DFS, and 5-year OS rate) between the 2 groups. The CA group had a higher number of patients reporting diarrhea and hand-foot syndrome compared with the 5-FU group. The 5-FU group had a higher number of patients reporting mucositis compared with the CA group. Conclusions: Our data suggested that oral CA was equivalent to continuous infusion 5-FU in the curative setting of rectal cancer during neoadjuvant chemoradiotherapy.

• 出版日期2017-9
• 单位广州医科大学