Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
West China Medical School, Sichuan University, Chengdu, 610041, China.
Langenbecks Arch Surg. 2024 Aug 6;409(1):242. doi: 10.1007/s00423-024-03414-9.
The value of upfront primary tumor resection (PTR) for asymptomatic unresectable metastatic colorectal cancer (mCRC) patients remains contentious. This meta-analysis aimed to assess the prognostic significance of upfront PTR for asymptomatic unresectable mCRC.
A systematic literature search was performed on June 21st, 2024. To minimize the bias and ensure robust evidence, only randomized controlled trials (RCTs) and case-matched studies (CMS) that compared PTR followed by chemotherapy to chemotherapy alone were included. The primary outcome was overall survival (OS), while cancer-specific survival (CSS) served as the secondary outcome.
Eight studies (three RCTs and five CMS) involving 1221 patients were included. Compared to chemotherapy alone, upfront PTR followed by chemotherapy did not improve OS (hazard ratios [HR] 0.91, 95% confidence interval [CI] 0.79-1.04, P = 0.17), but was associated with slightly better CSS (HR 0.59, 95% CI 0.40-0.88, P = 0.009).
The current limited evidence indicates that upfront PTR does not improve OS but may enhance CSS in asymptomatic unresectable mCRC patients. Ongoing trials are expected to provide more reliable evidence on this issue.
对于无症状不可切除转移性结直肠癌（mCRC）患者，初始原发肿瘤切除（PTR）的价值仍存在争议。本荟萃分析旨在评估初始 PTR 对无症状不可切除 mCRC 患者的预后意义。
于 2024 年 6 月 21 日进行系统文献检索。为了最大程度地减少偏倚并确保可靠的证据，仅纳入了比较 PTR 后化疗与单纯化疗的随机对照试验（RCT）和病例匹配研究（CMS）。主要结局为总生存期（OS），次要结局为癌症特异性生存期（CSS）。
纳入了 8 项研究（3 项 RCT 和 5 项 CMS），共计 1221 例患者。与单纯化疗相比，PTR 后化疗并未改善 OS（风险比 [HR] 0.91，95%置信区间 [CI] 0.79-1.04，P=0.17），但 CSS 略有改善（HR 0.59，95% CI 0.40-0.88，P=0.009）。
目前有限的证据表明，初始 PTR 并未改善 OS，但可能会提高无症状不可切除 mCRC 患者的 CSS。预期正在进行的试验将为这一问题提供更可靠的证据。
