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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/OL]. 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/OL]. 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
[1]
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2]
Kemeny N. Management of liver metastases from colorectal cancer[J]. Oncology (Williston Park), 2006, 20(10): 1161-1176, 1179.
[3]
Manfredi S, Lepage C, Hatem C, et al. Epidemiology and management of liver metastases from colorectal cancer[J]. Ann Surg, 2006, 244(2): 254-259.
[4]
Engstrand J, Nilsson H, Strömberg C, et al. Colorectal cancer liver metastases - a population-based study on incidence, management and survival[J]. BMC Cancer, 2018, 18(1): 78.
[5]
Kopetz S, Chang GJ, Overman MJ, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy[J]. J Clin Oncol, 2009, 27(22): 3677-3683.
[6]
Kanas GP, Taylor A, Primrose JN, et al. Survival after liver resection in metastatic colorectal cancer: review and Meta-analysis of prognostic factors[J]. Clin Epidemiol, 2012, 4: 283-301.
[7]
Inoue Y, Ishii M, Yokohama K, et al. Hepatectomy and liver regeneration in the results of treatment of colorectal liver metastasis[J]. Contemp Oncol (Pozn), 2020, 24(3): 172-176.
[8]
Akgül Ö, Çetinkaya E, Ersöz Ş, et al. Role of surgery in colorectal cancer liver metastases[J]. World J Gastroenterol, 2014, 20(20): 6113-6122.
[9]
Welsh FK, Tilney HS, Tekkis PP, et al. Safe liver resection following chemotherapy for colorectal metastases is a matter of timing[J]. Br J Cancer, 2007, 96(7): 1037-1042.
[10]
Malik HZ, Farid S, Al-Mukthar A, et al. A critical appraisal of the role of neoadjuvant chemotherapy for colorectal liver metastases: A case-controlled study[J]. Ann Surg Oncol, 2007, 14(12): 3519-3526.
[11]
Scoggins CR, Campbell ML, Landry CS, et al. Preoperative chemotherapy does not increase morbidity or mortality of hepatic resection for colorectal cancer metastases[J]. Ann Surg Oncol, 2009, 16(1): 35-41.
[12]
Boostrom SY, Nagorney DM, Donohue JH, et al. Impact of neoadjuvant chemotherapy with FOLFOX/FOLFIRI on disease-free and overall survival of patients with colorectal metastases[J]. J Gastrointest Surg, 2009, 13(11): 2003-2009.
[13]
Scartozzi M, Siquini W, Galizia E, et al. The timing of surgery for resectable metachronous liver metastases from colorectal cancer: better sooner than later? A retrospective analysis[J]. Dig Liver Dis, 2011, 43(3): 194-198.
[14]
Cucchetti A, Ercolani G, Cescon M, et al. Safety of hepatic resection for colorectal metastases in the era of neo-adjuvant chemotherapy[J]. Langenbecks Arch Surg, 2012, 397(3): 397-405.
[15]
Pinto Marques H, Barroso E, de Jong MC, et al. Peri-operative chemotherapy for resectable colorectal liver metastasis: does timing of systemic therapy matter?[J]. J Surg Oncol, 2012, 105(6): 511-519.
[16]
Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial[J]. Lancet Oncol, 2013, 14(12): 1208-1215.
[17]
Scilletta R, Pagano D, Spada M, et al. Comparative analysis of the incidence of surgical site infections in patients with liver resection for colorectal hepatic metastases after neoadjuvant chemotherapy[J]. J Surg Res, 2014, 188(1): 183-189.
[18]
Bonney GK, Coldham C, Adam R, et al. Role of neoadjuvant chemotherapy in resectable synchronous colorectal liver metastasis; An international multi-center data analysis using LiverMetSurvey[J]. J Surg Oncol, 2015, 111(6): 716-724.
[19]
Wiseman JT, Guzman-Pruneda F, Xourafas D, et al. Impact of neoadjuvant chemotherapy on the postoperative outcomes of patients undergoing liver resection for colorectal liver metastases: A population-based propensity-matched analysis[J]. J Am Coll Surg, 2019, 229(1): 69-77. e2.
[20]
Ratti F, Fuks D, Cipriani F, et al. Timing of perioperative chemotherapy does not influence long-term outcome of patients undergoing combined laparoscopic colorectal and liver resection in selected upfront resectable synchronous liver metastases[J]. World J Surg, 2019, 43(12): 3110-3119.
[21]
Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: A multicentre randomised trial[J]. Lancet, 2000, 355(9209): 1041-1047.
[22]
Saltz LB, Cox JV, Blanke C, et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group[J]. N Engl J Med, 2000, 343(13): 905-914.
[23]
de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer[J]. J Clin Oncol, 2000, 18(16): 2938-2947.
[24]
Nakano H, Oussoultzoglou E, Rosso E, et al. Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy[J]. Ann Surg, 2008, 247(1): 118-124.
[25]
Fernandez FG, Ritter J, Goodwin JW, et al. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases[J]. J Am Coll Surg, 2005, 200(6): 845-853.
[26]
Liu W, Zhou JG, Sun Y, et al. The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: A systematic review and Meta-analysis[J]. Oncotarget, 2016, 7(24): 37277-37287.
[27]
Kishi Y, Zorzi D, Contreras CM, et al. Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases[J]. Ann Surg Oncol, 2010, 17(11): 2870-2876.
[28]
Brouquet A, Benoist S, Julie C, et al. Risk factors for chemotherapy-associated liver injuries: A multivariate analysis of a group of 146 patients with colorectal metastases[J]. Surgery, 2009, 145(4): 362-371.
[29]
Kopetz S, Vauthey JN. Perioperative chemotherapy for resectable hepatic metastases[J]. Lancet, 2008, 371(9617): 963-965.
[30]
Macedo FI, Makarawo T. Colorectal hepatic metastasis: evolving therapies[J]. World J Hepatol, 2014, 6(7): 453-463.
[31]
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1 001 consecutive cases[J]. Ann Surg, 1999, 230(3): 309-318; discussion 318-321.
[32]
Nagashima I, Takada T, Adachi M, et al. Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: comparison of our scoring system to the positive number of risk factors[J]. World J Gastroenterol, 2006, 12(39): 6305-6309.
[33]
Parks R, Gonen M, Kemeny N, et al. Adjuvant chemotherapy improves survival after resection of hepatic colorectal metastases: analysis of data from two continents[J]. J Am Coll Surg, 2007, 204(5): 753-763.
[34]
Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range[J]. Stat Methods Med Res, 2018, 27(6): 1785-1805.
[35]
Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range[J]. BMC Med Res Methodol, 2014, 14: 135.
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