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

doi:10.3877/cma.j.issn.1674-0793.2022.02.015

Abstract

Abstract:

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.

Key words: Colorectal neoplasms, Liver matastases, Chemotherapy, adjuvant, Meta-analysis

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.

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References 35

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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)	③	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)

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)	③	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)

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