Rovers Koen P, Simkens Geert A, Punt Cornelis J, van Dieren Susan, Tanis Pieter J, de Hingh Ignace H
Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
Crit Rev Oncol Hematol. 2017 Jun;114:53-62. doi: 10.1016/j.critrevonc.2017.03.028. Epub 2017 Mar 24.
BACKGROUND/PURPOSE: Despite its widespread use, no randomised studies have investigated the value of perioperative systemic therapy as adjunct to cytoreduction and HIPEC for colorectal peritoneal metastases. This systematic review evaluated the available evidence, which consists of non-randomised studies only.
A systematic search identified studies that investigated the influence of neoadjuvant, adjuvant, or perioperative systemic therapy on overall survival (OS).
The 11 included studies (n=1708) were clinically heterogeneous and subject to selection bias. Studies on neoadjuvant systemic therapy revealed OS benefit (n=3), no OS benefit (n=1), and superiority of chemotherapy with bevacizumab vs. chemotherapy (n=2). Studies on adjuvant systemic therapy showed no OS benefit (n=3). Studies on perioperative systemic therapy demonstrated OS benefit (n=1), and superiority of modern vs. conventional systemic therapy(n=1).
Significant limitations of available evidence question the widespread use of perioperative systemic therapy in this setting, stress the need for randomised studies, and impede conclusions regarding optimal timing and regimens. Included studies may suggest a survival benefit of neoadjuvant systemic therapy.
背景/目的：尽管围手术期全身治疗作为细胞减灭术和热灌注化疗（HIPEC）辅助治疗用于结直肠癌腹膜转移已广泛应用，但尚无随机研究对其价值进行探究。本系统评价评估了仅由非随机研究构成的现有证据。
通过系统检索确定了探究新辅助、辅助或围手术期全身治疗对总生存期（OS）影响的研究。
纳入的11项研究（n = 1708）在临床方面存在异质性且有选择偏倚。关于新辅助全身治疗的研究显示总生存期有获益（n = 3）、无总生存期获益（n = 1）以及贝伐单抗化疗对比单纯化疗具有优势（n = 2）。关于辅助全身治疗的研究显示无总生存期获益（n = 3）。关于围手术期全身治疗的研究显示总生存期有获益（n = 1）以及现代全身治疗对比传统全身治疗具有优势（n = 1）。
现有证据存在的显著局限性对围手术期全身治疗在此情况下的广泛应用提出质疑，强调了开展随机研究的必要性，并阻碍了关于最佳时机和治疗方案的结论得出。纳入的研究可能提示新辅助全身治疗有生存获益。
