British journal of cancer · 2026
Neoadjuvant chemotherapy as a bridge to surgery versus direct surgery following SEMS placement in obstructive left-sided colon cancer: a multicenter prospective cohort study.
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Shi Yang, Zhai Zhi Wei, Cao Ke, Ye Chun Xiang, Li Yan Sen, Wang Yan Lei, Yang Kai Yan, Ding Zhao, Hu Xu Hua, Dai Yong, Qian Qun, Wang Gui Ying, Wang Zhen Jun, Han Jia Gang
Аннотация
OBJECTIVE: To investigate the perioperative complications and long-term outcomes of self-expanding metallic stent (SEMS) placement combined with neoadjuvant chemotherapy followed by elective surgery in patients with complete obstructive left-sided colon cancer (COLCC).
METHODS: A multicenter prospective study enrolled 246 COLCC patients, comparing SEMS-surgery (n = 105) and SEMS-neoadjuvant-surgery (n = 141). 1:1 propensity score matching (PSM) and 8-week landmark analyses were used to mitigate biases. Primary outcomes included SEMS-related complications, overall survival (OS), and disease-free survival (DFS).
RESULTS: In the PSM cohort (n = 206), SEMS-related complication rates were similar between the neoadjuvant and surgery-alone groups (15.5% vs. 14.6%, P = 0.845). The SEMS-neoadjuvant-surgery group demonstrated superior 5-year OS (66.2% vs. 51.7%, P < 0.001) and 5-year DFS (65.3% vs. 40.0%, P < 0.001). Landmark analysis consistently validated these survival benefits. Multivariable Cox regression confirmed neoadjuvant chemotherapy as an independent protective factor for both OS (HR = 0.436, 95% CI: 0.188-0.996, P = 0.015) and DFS (HR = 0.661, 95% CI: 0.551-0.830, P = 0.002).
CONCLUSION: The SEMS-neoadjuvant-surgery strategy is associated with superior long-term survival without increasing SEMS-related complications, strongly supporting its clinical feasibility and oncological safety for COLCC.
METHODS: A multicenter prospective study enrolled 246 COLCC patients, comparing SEMS-surgery (n = 105) and SEMS-neoadjuvant-surgery (n = 141). 1:1 propensity score matching (PSM) and 8-week landmark analyses were used to mitigate biases. Primary outcomes included SEMS-related complications, overall survival (OS), and disease-free survival (DFS).
RESULTS: In the PSM cohort (n = 206), SEMS-related complication rates were similar between the neoadjuvant and surgery-alone groups (15.5% vs. 14.6%, P = 0.845). The SEMS-neoadjuvant-surgery group demonstrated superior 5-year OS (66.2% vs. 51.7%, P < 0.001) and 5-year DFS (65.3% vs. 40.0%, P < 0.001). Landmark analysis consistently validated these survival benefits. Multivariable Cox regression confirmed neoadjuvant chemotherapy as an independent protective factor for both OS (HR = 0.436, 95% CI: 0.188-0.996, P = 0.015) and DFS (HR = 0.661, 95% CI: 0.551-0.830, P = 0.002).
CONCLUSION: The SEMS-neoadjuvant-surgery strategy is associated with superior long-term survival without increasing SEMS-related complications, strongly supporting its clinical feasibility and oncological safety for COLCC.