Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.
J Cancer Res Clin Oncol. 2020 Mar;146(3):545-553. doi: 10.1007/s00432-020-03142-9. Epub 2020 Feb 8.
Several studies have evaluated surgical resection of pulmonary metastases as a standard treatment option for colorectal cancer (CRC) patients with resectable pulmonary metastases. However, the role of peri-operative chemotherapy after complete resection of pulmonary metastases from CRC patients is still controversial. This systematic review and meta-analysis is aimed to investigate the clinical efficacy of peri-operative chemotherapy after resection of CRC pulmonary metastases.
PubMed, the Cochrane Library databases, and Embase were searched for studies evaluating the effect of peri-operative chemotherapy on the survival of patients with CRC after pulmonary metastasectomy. The hazard ratio (HR) was used for analyzing overall survival (OS) and progression-free survival (PFS)/recurrence-free survival (RFS)/disease-free survival (DFS).
Eight studies were included in the final analysis. The outcome showed that peri-operative chemotherapy had a significant favourable effect on OS (HR 0.83, 95% CI 0.75-0.92, p < 0.05) and PFS/RFS/DFS (HR 0.67, 95% CI 0.53-0.86, p < 0.05) in patients who received pulmonary metastasectomy. Multivariate analysis also validated this result (OS: HR 0.56, 95% CI 0.36-0.86, p < 0.05; PFS/RFS/DFS: HR 0.64, 95% CI 0.46-0.87, p < 0.05). There was a significant benefit in peri-operative group on OS and PFS/RFS/DFS in studies with R0 resection of pulmonary metastases (OS: HR 0.72, 95% CI 0.53-0.97, p < 0.05; PFS/RFS/DFS: HR 0.72, 95% CI 0.54-0.95, p < 0.05) and metachronous pulmonary metastases (OS: HR 0.40, 95% CI 0.22-0.75, p < 0.05; PFS/RFS/DFS: HR 0.67, 95% CI 0.49-0.92, p < 0.05).
Our meta-analysis demonstrated a significant difference in favor of peri-operative chemotherapy in CRC patients who underwent resection of pulmonary metastases. More clinical data and studies are needed to validate the findings of our study.
多项研究已经评估了肺转移灶切除术作为结直肠癌（CRC）患者可切除肺转移灶的标准治疗选择。然而，CRC 患者完全切除肺转移灶后围手术期化疗的作用仍存在争议。本系统评价和荟萃分析旨在研究 CRC 肺转移灶切除术后围手术期化疗的临床疗效。
检索 PubMed、Cochrane 图书馆数据库和 Embase，评估 CRC 肺转移瘤切除术患者围手术期化疗对生存影响的研究。使用风险比（HR）分析总生存期（OS）和无进展生存期（PFS）/无复发生存期（RFS）/无病生存期（DFS）。
最终分析纳入了 8 项研究。结果表明，在接受肺转移瘤切除术的患者中，围手术期化疗对 OS（HR 0.83，95%CI 0.75-0.92，p<0.05）和 PFS/RFS/DFS（HR 0.67，95%CI 0.53-0.86，p<0.05）有显著的有利影响。多变量分析也验证了这一结果（OS：HR 0.56，95%CI 0.36-0.86，p<0.05；PFS/RFS/DFS：HR 0.64，95%CI 0.46-0.87，p<0.05）。在 R0 切除肺转移灶的研究中（OS：HR 0.72，95%CI 0.53-0.97，p<0.05；PFS/RFS/DFS：HR 0.72，95%CI 0.54-0.95，p<0.05）和同时性肺转移（OS：HR 0.40，95%CI 0.22-0.75，p<0.05；PFS/RFS/DFS：HR 0.67，95%CI 0.49-0.92，p<0.05），围手术期组在 OS 和 PFS/RFS/DFS 方面有显著获益。
我们的荟萃分析表明，CRC 患者行肺转移灶切除术时，围手术期化疗有显著获益。需要更多的临床数据和研究来验证我们研究的结果。
