Bulisani Bruno Mirandola, Leite Milena Arruda de Oliveira, Waisberg Jaques
Centro Universitário FMABC, Santo André, SP, Brazil.
Einstein (Sao Paulo). 2024 Dec 9;22:eRW0596. doi: 10.31744/einstein_journal/2024RW0596. eCollection 2024.
The optimal approach to the treatment of colorectal carcinoma and synchronous liver metastases remains controversial. The objective of this review was to analyze the outcomes of adopting the liver-first approach for the treatment of patients with colorectal cancer with synchronous hepatic metastases who initially underwent systemic chemotherapy and/or resection of the metastatic lesions and primary colorectal carcinoma.
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, EMBASE, LILACS, and Cochrane Central Register of Controlled Trials databases were searched for the identification and retrieval of eligible studies. Studies that included details of using the liver-first approach for the treatment of synchronous liver metastases of colorectal cancer and its outcomes, including the patients' survival data, were included. Proportional meta-analysis was performed using the random-effects restricted maximum likelihood method to summarize the three- and five-year overall survival and recurrence rates of the patients.
Eight hundred and fifty-five articles describing the results of studies on the liver-first approach were identified. Three independent reviewers screened the titles and abstracts of the articles and excluded 750 articles. Thereafter, 29 retrospective and comparative studies that met the inclusion criteria were included. No randomized controlled trials were identified in the database search.
Neoadjuvant treatment with systemic chemotherapy for hepatic metastasis can prepare a patient for resection of liver metastases, offering the opportunity for potentially curative treatment of synchronous hepatic metastases initially considered unresectable. The decision regarding the resection of primary colorectal carcinoma and liver metastases should be based on individualized patient response. Prospero database registration ID: CRD42022337047 (www.crd.york.ac.uk/prospero).
结直肠癌伴同时性肝转移的最佳治疗方法仍存在争议。本综述的目的是分析采用肝优先方法治疗最初接受全身化疗和/或转移灶及原发性结直肠癌切除的同时性肝转移结直肠癌患者的疗效。
本综述按照系统评价和Meta分析的首选报告项目指南进行。检索MEDLINE、EMBASE、LILACS和Cochrane对照试验中央注册库数据库，以识别和检索符合条件的研究。纳入的研究包括使用肝优先方法治疗结直肠癌同时性肝转移的详细情况及其疗效，包括患者的生存数据。采用随机效应限制最大似然法进行比例Meta分析，以总结患者的三年和五年总生存率及复发率。
共识别出855篇描述肝优先方法研究结果的文章。三位独立评审员筛选了文章的标题和摘要，排除了750篇文章。此后，纳入了29项符合纳入标准的回顾性和比较性研究。在数据库检索中未识别出随机对照试验。
对肝转移进行全身化疗的新辅助治疗可为患者进行肝转移灶切除做好准备，为最初认为不可切除的同时性肝转移提供潜在治愈性治疗的机会。关于原发性结直肠癌和肝转移灶切除的决定应基于患者的个体化反应。Prospero数据库注册号：CRD42022337047（www.crd.york.ac.uk/prospero）。
