Gavriilidis Paschalis, Katsanos Konstantinos, Sutcliffe Robert P, Simopoulos Constantinos, Azoulay Daniel, Roberts Keith J
Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK.
Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, 26504 Patras, Greece.
J Clin Med Res. 2019 Aug;11(8):572-582. doi: 10.14740/jocmr3887. Epub 2019 Jul 27.
Systematic reviews and meta-analyses that compare simultaneous, delayed and liver-first approach for synchronous colorectal liver metastases have found no significant differences. The aim of this study was to determine the best treatment strategy on the basis of effect sizes and the probabilities of treatment ranking by using a network meta-analysis. Moreover, first-time pairwise and network meta-analyses were used to estimate the existing evidence, and their results were compared to detect any discrepancies between them.
Systematic review, pairwise meta-analysis and network meta-analysis were performed. The primary and secondary outcomes were 5-year overall survival and postoperative major morbidity, respectively.
No significant differences in long-term survival and major morbidity were found amongst the three approaches. The hazard ratios (95% confidence interval) for 5-year overall survival for the simultaneous, delayed and liver-first approaches were 0.93 (0.69 - 1.24, P = 0.613), 0.97 (0.87 - 1.07, P = 0.596) and 0.90 (0.67 - 1.22, P = 0.499), respectively. Moreover, the liver-first approach with a surface under the cumulative ranking area score of 89% was ranked as the potentially best treatment option based on probabilities of treatment ranking.
On the basis of the relative ranking of treatments, the liver-first approach ranked first, followed by the delayed and simultaneous approaches. Therefore, a three-arm randomized controlled trial that compares the liver-first, simultaneous and delayed approaches needs to shed further light as to which is the best treatment option.
比较同步、延迟和肝优先方法治疗同步性结直肠癌肝转移的系统评价和荟萃分析未发现显著差异。本研究的目的是通过网络荟萃分析，根据效应量和治疗排序概率确定最佳治疗策略。此外，首次使用成对和网络荟萃分析来评估现有证据，并比较其结果以检测它们之间的任何差异。
进行系统评价、成对荟萃分析和网络荟萃分析。主要和次要结局分别为5年总生存率和术后主要并发症。
三种方法在长期生存和主要并发症方面未发现显著差异。同步、延迟和肝优先方法的5年总生存风险比（95%置信区间）分别为0.93（0.69 - 1.24，P = 0.613）、0.97（0.87 - 1.07，P = 0.596）和0.90（0.67 - 1.22，P = 0.499）。此外，基于治疗排序概率，累积排序曲线下面积得分为89%的肝优先方法被列为潜在的最佳治疗选择。
根据治疗的相对排序，肝优先方法排名第一，其次是延迟和同步方法。因此，一项比较肝优先、同步和延迟方法的三臂随机对照试验需要进一步阐明哪种是最佳治疗选择。
