多种新辅助治疗策略已被用于直肠癌并进行了比较，但目前尚未达成最佳新辅助治疗方案的真正共识。本研究目的是识别和比较可用于II期和III期直肠癌的新辅助治疗方法。本系统性文献回顾检索涵盖MEDLINE、EMBASE、扩展科学引文索引和Cochrane图书馆等数据库，时间范围为从发布至2022年8月。只考虑比较II期和III期直肠癌新辅助治疗的随机对照试验。使用Stata软件绘制网络图，并通过WinBUGS软件中基于马尔科夫链蒙特卡罗方法开展贝叶斯网络荟萃分析。纳入了58篇文献，基于41项随机对照试验，共报道了12,404名接受了15种新辅助治疗方案的参与者。治疗方案在术后主要或全面并发症、吻合漏率或拯救括约肌保留手术方面没有显著差异。直接手术（STS）是预防手术前毒性最佳的治疗方案，但在阳性切除边缘和完全缓解方面排名最差。与长程放疗+短等待（LCCRT-SW）、长程放疗+长等待（LCCRT-LW）等待手术、短程放疗+短等待（SCRT-SW）或立即手术（SCRT-IS）比较，STS显著增加了阳性切除边缘的风险。LCCRT-SW或LCCRT-LW与STS相比，完全缓解率显著提高。LCCRT-LW显著提高了术后2年总生存率，优于STS、SCRT-IS和SCRT-SW。全新辅助治疗方案（SCRT-CT-SW）、诱导化疗后长程放疗+长程化疗（CT-LCCRT-S）以及长程放疗+化疗后巩固化疗（LCCRT-CT-S）与STS相比，阳性切除边缘、完全缓解和无病生存方面均有显著改善。chemotherapy with monoclonal antibodies followed by long-course chemoradiotherapy (CT+MAB-LCCRT+MAB-S)显著改善了缓解和阳性切除边缘，同时2年无病生存和综合生存与STS、SCRT-IS、SCRT-SW、SCRT-CT-SW、LCCRT-SW和LCCRT-LW相比也更显著。CT+MAB-LCCRT+MAB-S是最佳无病生存和总体生存治疗方法。短程放疗或长程放疗的传统新辅助治疗方法相对于未进行新辅助治疗的患者具有肿瘤学优势，而不会增加围手术期并发症，延长手术等待时间可能会改善肿瘤学预后。全新辅助治疗方案在完全缓解、阳性切除边缘和无病生存方面提供了额外的好处。单克隆抗体治疗可能进一步改善肿瘤学预后，但目前仅适用于少数患者，并需要进一步验证。© 2023 Elsevier B.V.版权所有。

Multiple neoadjuvant therapy strategies have been used and compared for rectal cancer and there has been no true consensus as to the optimal neoadjuvant therapy regimen. The aim is to identify and compare the neoadjuvant therapies available for stage II and III rectal cancer.A systematic literature review was performed, from inception to August 2022, of the following databases: MEDLINE, EMBASE, Science Citation Index Expanded, Cochrane Library. Only randomized controlled trials comparing neoadjuvant therapies for stage II and III rectal cancer were considered. Stata was used to draw network plots, and a Bayesian network meta-analysis was conducted through models utilizing the Markov Chain Monte Carlo method in WinBUGS.A total of 58 articles were included based on 41 randomised controlled trials, reporting on 12,404 participants that underwent 15 neoadjuvant treatment regimens. No significant difference was identified between treatments for major or total postoperative complications, anastomotic leak rates, or sphincter-saving surgery. Straight to surgery (STS) ranked as best treatment for preoperative toxicity but ranked worst treatment for positive resection margins and complete response. STS had significantly increased positive resection margins compared to long-course chemoradiotherapy with short-wait (LCCRT-SW) or long-wait (LCCRT-LW) to surgery, or short-course radiotherapy with short-wait (SCRT-SW) or immediate surgery (SCRT-IS). LCCRT-SW or LCCRT-LW resulted in significantly increased complete response rates compared to STS. LCCRT-LW significantly improved 2-year overall survival compared to STS, SCRT-IS, SCRT-SW. Total neoadjuvant therapy regimes with short-course radiotherapy followed by consolidation chemotherapy (SCRT-CT-SW), induction chemotherapy followed by long-course chemoradiotherapy (CT-LCCRT-S), long-course chemoradiotherapy followed by consolidation chemotherapy (LCCRT-CT-S), significantly improved positive resection margins, complete response, and disease-free survival compared to STS. Chemotherapy with monoclonal antibodies followed by long-course chemoradiotherapy (CT+MAB-LCCRT+MAB-S) significantly improved complete response and positive resection margins compared to STS, and 2-year disease-free survival compared to STS, SCRT-IS, SCRT-SW, SCRT-CT-SW, LCCRT-SW, LCCRT-LW. CT+MAB-LCCRT+MAB-S ranked as best treatment for disease-free survival and overall survival.Conventional neoadjuvant therapies with short-course radiation or long-course chemoradiotherapy have oncological benefits compared to no neoadjuvant therapy without increasing perioperative complication rates. Prolonged wait to surgery may improve oncological outcomes. Total neoadjuvant therapies provide additional benefits in terms of complete response, positive resection margins, and disease-free survival. Monoclonal antibody therapy may further improve oncological outcomes but currently is only applicable to a small subgroup of patients and requires further validation.Copyright © 2023 Elsevier B.V. All rights reserved.