Efficacy of perioperative chemotherapy in resected colorectal liver metastasis: A systematic review and meta-analysis.

Autor: Bosma NA; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada. Electronic address: nicholas.bosma@albertahealthservices.ca., Keehn AR; Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada., Lee-Ying R; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada., Karim S; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada., MacLean AR; Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada., Brenner DR; Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2021 Dec; Vol. 47 (12), pp. 3113-3122. Date of Electronic Publication: 2021 Jul 31.
DOI: 10.1016/j.ejso.2021.07.024
Abstrakt: Background: Nearly half of patients with colorectal cancer develop liver metastases. Radical resection of colorectal liver metastases (CRLM) offers the best chance of cure, significantly improving 5-year survival. Recurrence of metastatic disease is common, occurring in 60 % or more of patients. Clinical equipoise exists regarding the role of perioperative chemotherapy in patients with resected CRLM. This investigation sought to clarify the efficacy of perioperative chemotherapy in patients that have undergone curative-intent resection of CRLM.
Methods: A systematic review and meta-analysis was completed of randomized controlled trials (RCTs) comparing perioperative chemotherapy to surgery alone in patients with resected CRLM. MEDLINE (Ovid), EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, as well as abstracts from recent oncology conferences. A meta-analysis was performed pooling the hazard ratios for disease-free survival (DFS) and overall survival (OS), using a random-effects model.
Results: A total of five, phase 3, open-label, RCTs were included resulting in a pooled analysis of 1119 of the total 1146 enrolled patients. 559 patients were randomized to perioperative chemotherapy and 560 to surgery alone. Pooled estimates demonstrated a statistically significant improvement in DFS (HR 0.71, 95 % CI: 0.61-0.82; p < 0.001) but not OS (HR 0.87, 95 % CI: 0.73-1.04; p = 0.136).
Conclusion: Perioperative chemotherapy in the setting of resected CRLM resulted in an improvement in DFS, however this did not translate into an OS benefit. Poor compliance to post-hepatectomy oxaliplatin-based chemotherapy regimens was identified. Further investigation into the optimal regimen and sequencing of perioperative chemotherapy is justified.
Competing Interests: Declaration of competing interest The authors declare no conflict of interest.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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