Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
Ann Surg Oncol. 2022 Oct;29(11):6619-6631. doi: 10.1245/s10434-022-11699-7. Epub 2022 Apr 9.
Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-recognised treatment option for the management of colorectal peritoneal metastases (CRPM). However, incorporating the routine use of neoadjuvant chemotherapy (NAC) into this management plan is controversial.
A systematic review and meta-analysis were conducted to evaluate the impact of neoadjuvant chemotherapy on perioperative morbidity and mortality, and long-term survival of patients with CRPM undergoing CRS and HIPEC.
Twelve studies met the inclusion criteria (n = 2,463 patients). Ten were retrospective cohort, one was prospective cohort, and one was a prospective randomised by design. Patients who received NAC followed by CRS and HIPEC experienced no difference in major perioperative morbidity and mortality compared with patients who underwent surgery first (SF). There was no difference in overall survival at 3 years, but at 5 years NAC patients had superior survival (relative risk [RR] 1.31; 95% confidence interval [CI] 1.11-1.54, P < 0.001). There were no differences in 1- and 3-year, disease-free survival (DFS) between groups. Study heterogeneity was generally high across all outcome measures.
Patients who received neoadjuvant chemotherapy did not experience any increase in perioperative morbidity or mortality. The potential improvement in 5-year overall survival in patients receiving NAC is based on limited confidence due to several limitations in the data, but not sufficiently enough to curtail its use. The practice of NAC in this setting will remain heterogeneous and guided by retrospective evidence until prospective, randomised data are reported.
细胞减灭术（CRS）联合或不联合腹腔热灌注化疗（HIPEC）是治疗结直肠腹膜转移（CRPM）的一种公认的治疗选择。然而，将新辅助化疗（NAC）常规纳入这种治疗方案存在争议。
系统评价和荟萃分析评估了新辅助化疗对接受 CRS 和 HIPEC 的 CRPM 患者围手术期发病率和死亡率以及长期生存的影响。
符合纳入标准的研究有 12 项（n = 2463 名患者）。其中 10 项为回顾性队列研究，1 项为前瞻性队列研究，1 项为设计前瞻性随机研究。与先手术（SF）的患者相比，接受 NAC 后再行 CRS 和 HIPEC 的患者在主要围手术期发病率和死亡率方面没有差异。3 年总生存率无差异，但 5 年时 NAC 患者的生存率更高（相对风险 [RR] 1.31；95%置信区间 [CI] 1.11-1.54，P < 0.001）。两组患者的 1 年和 3 年无病生存率（DFS）无差异。所有结局指标的研究异质性普遍较高。
接受新辅助化疗的患者在围手术期发病率或死亡率方面没有增加。接受 NAC 的患者 5 年总生存率的潜在改善基于数据中的几个局限性存在较高的置信度，但还不足以限制其使用。在报告前瞻性随机数据之前，这种情况下 NAC 的应用仍将存在异质性，并基于回顾性证据进行指导。
