P0290 - Neoadjuvant Chemotherapy Versus Upfront Surgery for Locally Advanced Colon Cancer: A Systematic Review and Meta Analysis

Shruthi Raghunandan, ¹, Manisha P M. Sahadev, ¹, Vinay Chandramouli Bellur, ², Prakriti Ramamurthy, MBBS, MD³, Advaith N. Rao, MBBS⁴, Rahul Ravindra, MBBS, MD⁵, Thanisha Santhosh, MBBS⁴, Ananya Prasad, ⁶, Aryan Gupta, ⁷
1Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India; 2Ramaiah medical college, Bangalore, Karnataka, India; 3University of Massachusetts Chan Medical School - Baystate Health, Springfield, MA; 4M S Ramaiah Medical College, Bangalore, Karnataka, India; 5White River Medical Center, Batesville, AR; 6ramaiah medical college, Bangalore, Karnataka, India; 7Bangalore Medical College and Research Centre, Bengaluru, Karnataka, India

Introduction:

Currently, the standard of care for locally advanced colon cancer (LACC) is upfront surgery followed by adjuvant chemotherapy if required. In recent years, there has been an increase in evidence regarding the use of neoadjuvant chemotherapy. Despite good operative outcomes, data regarding survival and disease free survival remains obscure. This study aims to evaluate the effectiveness of neoadjuvant chemotherapy for LACC.

Methods: The review conducted follows the PRISMA guidelines and major medical databases, which include PUBMED, Google Scholar and Science Direct, were extensively searched using a comprehensive search term to identify and retrieve available articles. Randomized clinical trials and propensity matched cohort studies that included the assessment of Overall survival(OS) and Progress/Disease Free Survival(PFS/DFS) following Neoadjuvant Chemotherapy and Upfront surgery were included in the meta analysis.

 

The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The Odds Ratio (OR) of OS and PFS between the two groups for One , Three and Five years was assessed in the meta-analysis.The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The Mantel Haenszel method (common effect model)and the Inverse variance method (random effects model) were utilised to analyse the odds ratio. The I^2 test was used to assess the heterogeneity of the studies.

Results:

The study conducted involves a total of 6 studies with 1591 subjects receiving NACT and 1290 patients undergoing Upfront surgery for LACC. The Overall survival over one, three and five years did not significantly vart between the two groups.(OR (1Y) = 1.01(0.99 ; 1.03)95% CI , p = 0.67 , I^2 = 0%),(OR(3Y) = 1.03(1.00 ; 1.07)95%CI , p = 0.66 , I^2 = 0%),(OR(5Y)=1.05(1.00 ; 1.098)95%CI , p = 0.72). The 1-Year Progress free survival /disease-free survival did not significantly differ between the groups, The 3-year and 5-year progress-free survival were marginally higher in the NACT group.(PFS(3Y) = 1.09(1.04;1.13) 95% CI , p = 0.96 , I^2 = 0%),(PFS(5Y) = 1.08(1.02 ; 1.15)95% CI , p = 0.90 I^2 = 0%)

 

Discussion:

NACT proves to be effective in progressive free survival among LACC in comparison to Upfront surgery. The overall survival was similar in both groups, indicating similar therapeutic efficacy. NACT doesn’t provide a significant benefit in terms of OS and PFS, but studies indicate better histopathological response; further trials have to be conducted to conclude the same.  

Disclosures:


Shruthi Raghunandan, ¹, Manisha P M. Sahadev, ¹, Vinay Chandramouli Bellur, ², Prakriti Ramamurthy, MBBS, MD³, Advaith N. Rao, MBBS⁴, Rahul Ravindra, MBBS, MD⁵, Thanisha Santhosh, MBBS⁴, Ananya Prasad, ⁶, Aryan Gupta, ⁷. P0290 - Neoadjuvant Chemotherapy Versus Upfront Surgery for Locally Advanced Colon Cancer: A Systematic Review and Meta Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.