辅助化疗能否改善结直肠癌肺转移切除术后患者的预后？一项系统评价和荟萃分析。
Does adjuvant chemotherapy improve the prognosis of patients after resection of pulmonary metastasis from colorectal cancer? A systematic review and meta-analysis.
机构信息
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
出版信息
Int J Colorectal Dis. 2019 Oct;34(10):1661-1671. doi: 10.1007/s00384-019-03362-7. Epub 2019 Aug 24.
BACKGROUND
It remains controversial whether patients benefit from adjuvant chemotherapy (ACT) after resection of pulmonary metastasis (PM) from colorectal cancer (CRC). This meta-analysis was intended to evaluate the efficacy of ACT in patients after resection of PM from CRC.
METHODS
We systematically retrieved articles from PMC, PubMed, Cochrane Library, and Embase (up to March 5, 2019). Survival data, including overall survival (OS) and disease-free survival (DFS), were tested by hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS
We included 18 cohort studies with a total of 3885 patients. The meta-analysis showed that ACT had no significant effect on OS (HR = 0.78; 95% CI = 0.60-1.03; P = 0.077) and DFS (HR = 0.91; 95% CI = 0.74-1.11; P = 0.339) in patients after resection of PM from CRC. There was no significant difference in OS (HR = 0.79; 95% CI = 0.42-1.50; P = 0.474) in patients after resection of PM from CRC treated with bevacizumab (BV). Subgroup analysis showed that ACT did not improve OS (HR = 0.86; 95% CI = 0.57-1.29; P = 0.461) in patients who had undergone previous resection of extra PM. ACT did not improve OS in patients who had positive hilar/mediastinal lymph node metastasis (HR = 0.80; 95% CI = 0.57-1.14; P = 0.22).
CONCLUSION
In conclusion, ACT does not provide survival benefits for patients after resection of PM from CRC. ACT and targeted agents (BV) are not suggested for these patients.
背景
结直肠癌（CRC）肺转移（PM）切除术后患者是否从辅助化疗（ACT）中获益仍存在争议。本meta 分析旨在评估 ACT 对 CRC 肺转移切除术后患者的疗效。
方法
我们系统地从 PMC、PubMed、Cochrane 图书馆和 Embase（截至 2019 年 3 月 5 日）检索文献。通过风险比（HR）和 95%置信区间（CI）检测生存数据，包括总生存（OS）和无病生存（DFS）。
结果
我们纳入了 18 项队列研究，共 3885 例患者。meta 分析显示，ACT 对 CRC 肺转移切除术后患者的 OS（HR=0.78；95%CI=0.60-1.03；P=0.077）和 DFS（HR=0.91；95%CI=0.74-1.11；P=0.339）无显著影响。贝伐珠单抗（BV）治疗 CRC 肺转移切除术后患者 OS（HR=0.79；95%CI=0.42-1.50；P=0.474）无显著差异。亚组分析显示，ACT 不能改善有既往肺外转移切除史患者的 OS（HR=0.86；95%CI=0.57-1.29；P=0.461）。ACT 不能改善有阳性肺门/纵隔淋巴结转移患者的 OS（HR=0.80；95%CI=0.57-1.14；P=0.22）。
结论
ACT 不能为 CRC 肺转移切除术后患者提供生存获益。不建议这些患者采用 ACT 和靶向药物（BV）。
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