Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium; Department of Surgery, Division of GI Surgery, Ghent University Hospital, Belgium.
Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Belgium.
Eur J Surg Oncol. 2020 Jul;46(7):1203-1213. doi: 10.1016/j.ejso.2020.02.040. Epub 2020 Mar 6.
The ideal treatment approach for colorectal cancer (CRC) with synchronous liver metastases (SCRLM) remains debated. We performed a network meta-analysis (NMA) comparing the 'bowel-first' approach (BFA), simultaneous resection (SIM), and the 'liver-first' approach (LFA).
A systematic search of comparative studies in CRC with SCRLM was undertaken using the Embase, PubMed, Web of Science, and CENTRAL databases. Outcome measures included postoperative complications, 30- and 90-day mortality, chemotherapy use, treatment completion rate, 3- and 5-year recurrence-free survival, and 3- and 5-year overall survival (OS). Pairwise and network meta-analysis were performed to compare strategies. Heterogeneity was assessed using the Higgins I statistic.
One prospective and 43 retrospective studies reporting on 10 848 patients were included. Patients undergoing the LFA were more likely to have rectal primaries and a higher metastatic load. The SIM approach resulted in a higher risk of major morbidity and 30-day mortality. Compared to the BFA, the LFA more frequently resulted in failure to complete treatment as planned (34% versus 6%). Pairwise and network meta-analysis showed a similar 5-year OS between LFA and BFA and a more favorable 5-year OS after SIM compared to LFA (odds ratio 0.25-0.90, p = 0.02, I = 0%), but not compared to BFA.
Despite a higher tumor load in LFA compared to BFA patients, survival was similar. A lower rate of treatment completion was observed with LFA. Uncertainty remains substantial due to imprecise estimates of treatment effects. In the absence of prospective trials, treatment of stage IV CRC patients should be individually tailored.
结直肠癌伴同步肝转移（SCRLM）的理想治疗方法仍存在争议。我们进行了一项网状荟萃分析（NMA），比较了“肠道优先”方法（BFA）、同期切除（SIM）和“肝脏优先”方法（LFA）。
使用 Embase、PubMed、Web of Science 和 CENTRAL 数据库对 SCRLM 结直肠癌的比较研究进行了系统检索。主要观察指标包括术后并发症、30 天和 90 天死亡率、化疗使用率、治疗完成率、3 年和 5 年无复发生存率以及 3 年和 5 年总生存率（OS）。采用成对和网状荟萃分析比较策略。采用 Higgins I 统计量评估异质性。
纳入了一项前瞻性研究和 43 项回顾性研究，共纳入了 10848 例患者。接受 LFA 的患者更可能患有直肠原发肿瘤和更高的转移负荷。SIM 方法导致严重发病率和 30 天死亡率更高。与 BFA 相比，LFA 更常导致无法按计划完成治疗（34%比 6%）。成对和网状荟萃分析显示，LFA 和 BFA 的 5 年 OS 相似，与 LFA 相比，SIM 的 5 年 OS 更有利（比值比 0.25-0.90，p=0.02，I=0%），但与 BFA 相比无差异。
尽管 LFA 患者的肿瘤负荷高于 BFA 患者，但生存率相似。LFA 组的治疗完成率较低。由于治疗效果的估计不精确，不确定性仍然很大。在没有前瞻性试验的情况下，应根据个体情况为 IV 期 CRC 患者量身定制治疗方案。
