Meta-analysis Of The Survival Prognosis Of Watch And Wait Strategy In Patients With Rectal Cancer After Neoadjuvant Chemoradiotherapy And Achieve Clinical Complete Response

Objective: To evaluate the survival prognosis of watch and wait(W&W)strategy in patients with rectal cancer after neoadjuvant chemoradiotherapy and achieve clinical complete response.Methods: Eligible literatures were retrieved from Pub Med,The Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI)and Wanfang databases up to December 31,2020.Patients’ survival prognosis were compared between W&W strategy and radical surgery for rectal cancer with neoadjuvant chemoradiotherapy and achieved clinical complete response.Local recurrence(LR),distant metastasis(DM),cancer-related death(CRD),2-year,3-year,5-year disease-free survival(DFS)and overall survival(OS)were set as endpoints.Data were extracted by two reviewers independently.The Rev Man 5.3 software was used for statistical analysis.Results: According to inclusion and exclusion criteria,10 studies with831 patients were finally included.Among them,5 studies’ quality were high and 5 studies’ quality were medium.In 6 studies,patients were included in the p CR group according to the postoperative pathological results which showed pathological complete response(p CR).There were 190 cases in the W&W group and 204 cases in the p CR group.4 of the studies were included in the surgical treatment(ST)group due to no clear postoperative pathological results provided.There were 130 cases in W&W group and 304 cases in ST group.Meta-analysis showed the risk of LR was higher in the W&W group than in the p CR group(RR: 5.49 95%CI:1.71-17.69,P=0.004)and the ST group(RR: 5.38 95%CI:1.62-17.87,P=0.006).There were no significant differences found in DM,CRD,2-year,3-year and 5-year DFS,2-year,3-year and 5-year OS in patients of W&W group when compared with those in p CR group and ST group.Conclusions: The W&W strategy might increase the risk of LR in patients with rectal cancer.If LR occurs,radical surgical salvage therapy can be performed.W&W strategy showed no significant difference in survival prognostic indicators as DM,CRD,2-year,3-year,5-year DFS and OS when compared with radical surgery.Therefore,W&W strategy might be a promising strategy for rectal cancer patients with c CR after NCRT.