Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore.
J Vasc Interv Radiol. 2021 Nov;32(11):1536-1545.e38. doi: 10.1016/j.jvir.2021.05.032. Epub 2021 Jun 22.
To evaluate the efficacy of hepatic arterial infusion (HAI), conventional transarterial chemoembolization, drug-eluting embolic transarterial chemoembolization (DEE-TACE), transarterial radioembolization, and their combinations with systemic chemotherapy (SCT) for unresectable colorectal liver metastases.
A search was conducted on Embase, Scopus, PubMed, and Web of Science for prospective nonrandomized studies and randomized controlled trials (RCTs) from inception to June 20, 2020. Survival data of patients were recovered from original Kaplan-Meier curves by exploiting a graphical reconstructive algorithm. One-stage meta-analyses were conducted for the median overall survival (OS), survival rates (SRs), and restricted mean survival time (RMST), whereas two-stage meta-analyses of proportions were conducted to determine response rates (RRs) and conversion to resection rates (CRRs).
A total of 71 prospective nonrandomized studies and 21 RCTs were identified, comprising 6,695 patients. Among patients treated beyond the first-line, DEE-TACE + SCT (n = 152) had the best survival outcomes of median OS of 26.5 (95% confidence interval [CI], 22.5-29.1) months and a 3-year RMST of 23.6 (95% CI, 21.8-25.5) months. Upon further stratification by publication year, DEE-TACE + SCT appeared to consistently have the highest pooled SRs at 1 year (81.9%) and 2 years (66.1%) in recent publications (2015-2020). DEE-TACE + SCT and HAI + SCT had the highest pooled RRs of 56.7% (I = 0.90) and 62.6% (I = 0.87) and pooled CRRs of 35.5% (I = 0.00) and 30.3% (I = 0.80), respectively.
Albeit significant heterogeneity, the paucity of high-quality evidence, and the noncomparative nature of all analyses, the overall evidence suggests that patients treated with DEE-TACE + SCT have the best oncological outcomes and greatest potential to be converted for resection.
评估肝动脉灌注（HAI）、常规经动脉化疗栓塞术、载药微球栓塞化疗栓塞术（DEE-TACE）、经动脉放射性栓塞术及其与系统化疗（SCT）联合治疗不可切除结直肠癌肝转移的疗效。
在 Embase、Scopus、PubMed 和 Web of Science 上检索了从成立到 2020 年 6 月 20 日的前瞻性非随机研究和随机对照试验（RCT）。通过图形重建算法从原始 Kaplan-Meier 曲线中恢复患者的生存数据。对中位总生存期（OS）、生存率（SRs）和受限平均生存时间（RMST）进行了单阶段荟萃分析，而对反应率（RRs）和转化为切除率（CRRs）进行了两阶段荟萃分析。
共纳入 71 项前瞻性非随机研究和 21 项 RCT，共纳入 6695 例患者。在一线治疗之外，DEE-TACE+SCT（n=152）治疗患者的生存结局最佳，中位 OS 为 26.5 个月（95%置信区间 [CI]，22.5-29.1），3 年 RMST 为 23.6 个月（95% CI，21.8-25.5）。进一步按发表年份分层，DEE-TACE+SCT 在最近的出版物（2015-2020 年）中似乎始终具有最高的 1 年（81.9%）和 2 年（66.1%）的 pooled SRs。DEE-TACE+SCT 和 HAI+SCT 的 pooled RR 最高，分别为 56.7%（I=0.90）和 62.6%（I=0.87），pooled CRR 分别为 35.5%（I=0.00）和 30.3%（I=0.80）。
尽管存在显著的异质性、高质量证据的缺乏以及所有分析的非比较性，但总体证据表明，接受 DEE-TACE+SCT 治疗的患者具有最佳的肿瘤学结果，并且最有可能进行切除。
