Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 28, 2020; 8(1): 27-40
Published online Feb 28, 2020. doi: 10.13105/wjma.v8.i1.27
Long-term efficacy of capecitabine plus oxaliplatin chemotherapy on stage III colon cancer: A meta-analysis
Hong-Tao Fu, Ying-Ying Xu, Jing-Jing Tian, Jia-Xin Fu, Shao-Ling Nie, Yan-Yan Tang, Ping Chen, Liang Zong
Hong-Tao Fu, Department of Clinical Medicine, University of South China, Hengyang 421000, Hunan Province, China
Ying-Ying Xu, Department of General Surgery, Yizheng People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
Jing-Jing Tian, Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Jia-Xin Fu, Ping Chen, Liang Zong, Department of General Surgery, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China
Shao-Ling Nie, Yan-Yan Tang, Department of Colorectal Surgery, Hunan Cancer Hospital, Central South University, Changsha 410000, Hunan Province, China
Author contributions: Fu HT, Xu YY, Tian JJ and Fu JX contributed equally to this work; Zong L and Nie SL were responsible for the conception and design of the study; Fu HT, Tian JJ, Xu YY and Fu JX collected the data and organized data extraction sheets; Fu HT and Tian JJ statistically analyzed the data; Fu HT drafted the manuscript, with critical revision being performed by Zong L and Nie SL.
Conflict-of-interest statement: The authors have no conflicts of interest for this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Liang Zong, PhD, Doctor, Professor, Department of General Surgery, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou 225000, Jiangsu Province, China. 250537471@qq.com
Received: June 22, 2019
Peer-review started: June 24, 2019
First decision: August 27, 2019
Revised: September 26, 2019
Accepted: October 20, 2019
Article in press: October 20, 2019
Published online: February 28, 2020
Processing time: 252 Days and 8.4 Hours
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer (CRC) accounts for 9% of all cancers in the world. In the last decade, it is the third most common malignant tumor in Europe and the United States. There is an urgent need to establish an effective standard treatment for CRC. In addition, more than 70% of CRC-related deaths are associated with the liver metastasis. A recurrence rate and poor overall survival make CRC a serious public health problem.

Research motivation

The aim of treatment for CRC is to cure locally and prevent metastasis and recurrence. Generally, comprehensive treatment is the focus of CRC, and chemotherapy is one of the important treatment methods. Reasonable and effective chemotherapy can prolong the life span and improve the quality of life of patients. Therefore, local resection of colon cancer should be combined with individual treatment. For patients with CRC, the choice of chemotherapy is very important for their prognosis. In patients with CRC, the purpose of adjuvant chemotherapy is to eliminate the occult micrometastasis during surgery, so as to improve the overall survival.

Research objectives

The purpose of this study was to explore the efficacy of capecitabine plus oxaliplatin (XELOX) regimen over other chemotherapy regimens, specifically XELOX vs 5-fluorouracil plus leucovorin, XELOX vs 5-fluorouracil plus leucovorin plus oxaliplatin, XELOX vs capecitabine and XELOX vs oxaliplatin plus 5-fluorouracil.

Research methods

By searching the PubMed, EMBASE and Cochrane databases, a total of 12 randomized controlled trials involving 6698 stage III colon cancer cases (XELOX protocol: n = 3298 cases; other adjuvant chemotherapy protocol: n = 3268 cases) were included. The parameter outcomes included the overall survival and the disease-free survival. The quality control of selected literature was based on the Jadad scale and the GRADE system.

Research results

In comparison to other adjuvant chemotherapy regimen, the XELOX regimen showed a better overall survival and a better disease-free survival for colon cancer patients.

Research conclusions

In clinical application, XELOX and 5-fluorouracil plus leucovorin plus oxaliplatin showed similar efficacy, but different types of patients may have different benefits from treatment. According to our data, in comparison to other adjuvant chemotherapy regimen, XELOX regimen showed a better overall survival and a better disease-free survival for colon cancer patients, suggesting the XELOX regimen can be a good option for postoperative treatment of stage III colon cancer.

Research perspectives

The XELOX regimen is recommended for stage III colon cancer after surgery. In addition, our conclusion needs to be further validated by a large RCT trial in future.