Clancy Cillian, Burke John P, Barry Mitchel, Kalady Matthew F, Calvin Coffey J
Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland,
Ann Surg Oncol. 2014 Nov;21(12):3900-8. doi: 10.1245/s10434-014-3805-4. Epub 2014 May 22.
Approximately 20 % of patients diagnosed with colorectal cancer will have distant metastases at first presentation (stage IV disease). The effect of removing the primary tumor on survival for patients with stage IV disease with unresectable metastases remains unclear. To address this a meta-analysis of all studies comparing primary tumor resection with chemotherapy alone in cases of stage IV colorectal cancer with unresectable metastases was performed.
A comprehensive search for published studies examining the effect of primary tumor resection in the setting of colorectal cancer with unresectable metastases was performed. Each study was reviewed and data extracted. Random-effects methods were used to combine data.
There were 21 studies including a total of 44,226 patients that met the inclusion criteria. Resection of the primary tumor in patients with unresectable metastases compared with chemotherapy alone was associated with a lower mortality risk (OR 0.28; 95 % CI 0.165-0.474; P < 0.001), translating into a difference in mean survival of 6.4 months in favor of resection (95 % CI 5.025-7.858, P < 0.001). Patients who underwent resection of the primary tumor were more likely to have liver metastasis only (OR 1.551; 95 % CI 1.247-1.929; P < 0.001), were less likely to have ≥2 metastasis (OR 0.653; 95 % CI 0.508-0.839; P = 0.001), and were less likely to have rectal cancer (OR 0.495; 95 % CI 0.390-0.629; P < 0.001). There was significant cross-study heterogeneity.
Resection of the primary tumor may confer a survival advantage in stage IV colorectal cancer with unresectable metastases but significant selection bias exists in current studies. Randomized controlled trials are essential to validate these findings.
约20%被诊断为结直肠癌的患者在初次就诊时会出现远处转移（IV期疾病）。对于伴有不可切除转移灶的IV期疾病患者，切除原发肿瘤对生存的影响仍不明确。为解决这一问题，我们对所有比较伴有不可切除转移灶的IV期结直肠癌患者原发肿瘤切除与单纯化疗的研究进行了荟萃分析。
全面检索已发表的研究，这些研究探讨了在伴有不可切除转移灶的结直肠癌情况下原发肿瘤切除的效果。对每项研究进行了评估并提取了数据。采用随机效应方法合并数据。
有21项研究，共纳入44226例符合纳入标准的患者。与单纯化疗相比，伴有不可切除转移灶的患者切除原发肿瘤与较低的死亡风险相关（比值比0.28；95%置信区间0.165 - 0.474；P < 0.001），这意味着切除组的平均生存期延长6.4个月（95%置信区间5.025 - 7.858，P < 0.001）。接受原发肿瘤切除的患者更可能仅发生肝转移（比值比1.551；95%置信区间1.247 - 1.929；P < 0.001），发生≥2处转移的可能性较小（比值比0.653；95%置信区间0.508 - 0.839；P = 0.001），患直肠癌的可能性较小（比值比0.495；95%置信区间0.390 - 0.629；P < 0.001）。存在显著的研究间异质性。
对于伴有不可切除转移灶的IV期结直肠癌患者，切除原发肿瘤可能带来生存优势，但目前的研究存在显著的选择偏倚。随机对照试验对于验证这些发现至关重要。
