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中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 155 -160. doi: 10.3877/cma.j.issn.1674-0793.2022.02.015

循证医学

新辅助化疗治疗初始可切除结直肠癌肝转移效果的Meta分析
姬哲1, 高瞻鹏1, 董胜利1,()   
  1. 1. 030001 太原,山西医科大学第二医院普外科
  • 收稿日期:2021-11-18 出版日期:2022-04-01
  • 通信作者: 董胜利

Impact of neoadjuvant chemotherapy on patients with resectable colorectal cancer liver metastases: A Meta-analysis

Zhe Ji1, Zhanpeng Gao1, Shengli Dong1,()   

  1. 1. Department of General Surgery, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2021-11-18 Published:2022-04-01
  • Corresponding author: Shengli Dong
引用本文:

姬哲, 高瞻鹏, 董胜利. 新辅助化疗治疗初始可切除结直肠癌肝转移效果的Meta分析[J]. 中华普通外科学文献(电子版), 2022, 16(02): 155-160.

Zhe Ji, Zhanpeng Gao, Shengli Dong. Impact of neoadjuvant chemotherapy on patients with resectable colorectal cancer liver metastases: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(02): 155-160.

目的

通过对使用新辅助化疗后行手术治疗和单纯手术治疗的初始可切除的结直肠癌肝转移(CRLM)患者进行Meta分析,以评价新辅助化疗治疗初始可切除CRLM的效果。

方法

检索PubMed、Cochrane Library、Embase、中国知网、万方数据库2006年1月至2021年1月收录的关于接受新辅助化疗后行手术治疗(新辅助化疗组)和单纯手术(单纯手术组)治疗初始可切除的CRLM患者的相关文献。采用RevMan 5.4软件处理数据并进行荟萃分析。

结果

共纳入12篇文献6 644例患者,其中新辅助化疗组3 348例,单纯手术组3 296例。单纯手术组3年无病生存率优于新辅助化疗组(OR=0.57,95% CI:0.48~0.68,P<0.001),手术时间更短(WMD=13,95% CI:12.78~13.22,P<0.001)。而两组并发症发生率、肝内复发率、住院时间、5年总生存率的比较,差异无统计学意义。

结论

初始可切除的CRLM患者接受新辅助化疗是安全的,但长期获益并不明显。临床风险评分不失为一种好的策略,对于存在高复发风险的CRLM患者,行新辅助化疗可能延长生存时间。

Objective

To evaluate the effect of neoadjuvant chemotherapy in the treatment of primary resectable colorectal liver metastases (CRLM) through Meta-analysis.

Methods

A literature search was performed in PubMed, Cochrane Library, Embase, CNKI and Wanfang databases from January 2006 to January 2021. The assessment data about patients receiving neoadjuvant chemotherapy were collected and processed using RevMan 5.4 software for Meta-analysis.

Results

A total of 6 644 patients from 12 relevant literatures were enrolled in this study, including 3 348 patients in the neoadjuvant chemotherapy group and 3 296 patients in the operation group. The 3-year disease-free survival rate of the operation group was better than that of the neoadjuvant chemotherapy group (OR=0.57, 95% CI: 0.48-0.68, P<0.001), the operative time was shorter (WMD=13, 95% CI: 12.78-13.22, P<0.001). There were no significant differences in complication rate, intrahepatic recurrence rate, length of hospital stay and 5-year overall survival rate between the two groups.

Conclusions

Neoadjuvant chemotherapy is safe for patients with initially resectable CRLM, but the long-term benefit is not obvious. Clinical risk score is a good strategy. Neoadjuvant chemotherapy may prolong the survival time of patients with high recurrence risk.

表1 纳入文献的基本特征
纳入文献 组别 男/女 研究类型 化疗方案 化疗周期 转移数目(个) 结局指标 文献质量
Welsh, 2007[9] 新辅助化疗组 168/84 回顾 FOLFOX 4~6 1~3(207), ≥4(43) ①④ 7
  单纯手术组 163/82       1~3(211), ≥4(33)    
Malik, 2007[10] 新辅助化疗组 53/31 回顾 FOLFOX 6~12 4(mean) ①②⑤⑥ 8
  单纯手术组 54/30       4.5(mean)    
Scoggins, 2009[11] 新辅助化疗组 67/45 回顾 FOLFOX NR 2(mean) ①②③ 8
  单纯手术组 38/36       1(mean)    
Boostrom, 2009[12] 新辅助化疗组 28/16 回顾 FOLFOX NR NR ②③⑥ 8
  单纯手术组 30/25       NR    
Scartozzi, 2011[13] 新辅助化疗组 23/37 回顾 FOLFOX 6 1(40), >1(20) ③⑥ 8
  单纯手术组 23/21       1(27), >1(17)    
Cucchetti, 2012[14] 新辅助化疗组 27/20 回顾 FOLFOX 6 1~3(39), ≥4(8) ①④⑤ 6
  单纯手术组 27/20       1~3(38), ≥4(9)    
Pinto, 2012[15] 新辅助化疗组 207/127 回顾 FOLFOX 6 2.8±2.2(mean, SD) ①②③⑤ 8
  单纯手术组 237/105       1.8±1.6(mean, SD)    
Nordlinger, 2013[16] 新辅助化疗组 127/54 RCT FOLFOX 6 1-3(170),≥4(12) 7
  单纯手术组 114/65       1-3(166),≥4(16)    
Scilletta, 2014[17] 新辅助化疗组 29/23 回顾 FOLFOX 6 NR ①④⑤ 8
  单纯手术组 74/55       NR    
Bonney, 2015[18] 新辅助化疗组 418/275 回顾 FOLFOX ≥3 1(266), >1(427) ②③⑥ 9
  单纯手术组 370/238       1(358), >1(250)    
Wiseman, 2019[19] 新辅助化疗组 836/580 回顾 FOLFOX NR 1-3(1201), ≥4(215) ①④⑤ 7
  单纯手术组 803/613       1-3(1234), ≥4(182)    
Ratti, 2019[20] 新辅助化疗组 39/34 回顾 FOLFOX NR 2(mean) ①②③④⑤⑥ 8
  单纯手术组 41/32       2(mean)    
图1 两组患者并发症发生率的Meta分析森林图
图2 两组患者3年无病生存率的Meta分析森林图
图3 两组患者5年总生存率的Meta分析森林图
图4 两组患者手术时间的Meta分析森林图
图5 两组患者住院时间的Meta分析森林图
图6 两组患者肝内复发率的Meta分析森林图
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