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Meta-Analysis
. 2024 May 1;110(5):3030-3038.
doi: 10.1097/JS9.0000000000001175.

Optimal duration of oxaliplatin-based adjuvant chemotherapy in patients with different risk factors for stage II-III colon cancer: a meta-analysis

Ziyu Kuang  1   2 , Jiaxi Wang  1 , Kexin Liu  1   2 , Jingyuan Wu  1   2 , Jie Li  1
Affiliations
Meta-Analysis

Optimal duration of oxaliplatin-based adjuvant chemotherapy in patients with different risk factors for stage II-III colon cancer: a meta-analysis

Ziyu Kuang et al. Int J Surg. .

Abstract

Background: The duration of oxaliplatin-based chemotherapy in high-risk stage II, low-risk stage III, and high-risk stage III colon cancer (CC) patients is controversial. To reduce the risk of adverse events (AEs) without compromising efficacy while improving chemotherapy compliance is crucial.

Methods: The authors searched Cochrane, Embase, Pubmed, and Web of Science databases for articles from inception to August 8, 2023, the main outcomes were disease-free survival, overall survival, chemotherapy completion rates, and AE frequency.

Results: Six randomized controlled trials (RCTs) involving 10 332 patients were included. Disease-free survival analysis revealed that only the high-risk stage III CC patients experienced better results with the 6-month FOLFOX regimen when compared with the 3-month regimen [Hazard ratio (HR): 1.32, 95% CI: 1.15-1.51, P <0.0001). Overall survival (OS) analysis revealed that extending the use of FOLFOX and CAPEOX regimens did not provide survival benefits for stage III CC patients (HR: 1.16, 95% CI: 0.9-1.49, and HR: 0.89, 95% CI: 0.67-1.18, P =0.40). The completion rate of the 3-month oxaliplatin-based adjuvant chemotherapy regimen was significantly higher than that of the 6-month regimen [Relative risk (RR): 1.16, 95% CI: 1.06-1.27, P =0.002]. Moreover, the 3-month regimen had significantly lower AE rates than the 6-month regimen (RR: 0.62, 95% CI: 0.57-0.68, P <0.00001), with differences mainly concentrated in grade 3/4 neutropenia (RR: 0.70, 95% CI: 0.59-0.85, P =0.0002), peripheral sensory neuropathy at ≥grade 2 (RR: 0.45, 95% CI: 0.38-0.53, P <0.00001), and hand-foot syndrome at ≥grade 2 (RR: 0.36, 95% CI: 0.17-0.77, P =0.009).

Conclusion: The 6-month FOLFOX regimen should only be recommended for high-risk stage III CC, while the 3-month regimen can be recommended for other stages. A 3-month CAPEOX regimen can be recommended for stage II-III CC.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study selection flowchart.
Figure 2
Figure 2
Risk of bias summary for all included studies.
Figure 3
Figure 3
Assessment of disease-free survival (DFS) between 3M FOLFOX and 6M FOLFOX.
Figure 4
Figure 4
Assessment of disease-free survival (DFS) between 3M CAPEOX and 6M CAPEOX.
Figure 5
Figure 5
Assessment of overall Survival (OS) between 3M CAPEOX and 6M CAPEOX.
Figure 6
Figure 6
Assessment of completion of 3M arm and 6M arm.
Figure 7
Figure 7
Assessment of safety.
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