PDF(Pubmed)
Abstract：
BACKGROUND: Colorectal cancer (CRC) is the 3rd most common malignancy with the liver being the most common site of metastases. The recurrence rate of colorectal liver metastases (CRLM) after liver resection (LR) is notably high, with an estimated 40% of patients experiencing recurrence within 6 months. In this context, we conducted a meta-analysis to synthesize and evaluate the reliability of evidence pertaining to prognostic factors associated with early recurrence (ER) in CRLM following LR.
METHODS: Systematic searches were conducted from the inception of databases to July 14, 2023, to identify studies reporting prognostic factors associated with ER. The Quality in Prognostic Factor Studies (QUIPS) tool was employed to assess risk-of-bias for included studies. Meta-analysis was then performed on these prognostic factors, summarized by forest plots. The grading of evidence was based on sample size, heterogeneity, and Egger\'s P value.
RESULTS: The study included 24 investigations, comprising 12705 individuals, during an accrual period that extended from 2007 to 2023. In the evaluation of risk-of-bias, 22 studies were rated as low/moderate risk, while two studies were excluded because of high risk. Most of the studies used a postoperative interval of 6 months to define ER, with 30.2% (95% confidence interval [CI], 24.1-36.4%) of the patients experiencing ER following LR. 21 studies were pooled for meta-analysis. High-quality evidence showed that poor differentiation of CRC, larger and bilobar-distributed liver metastases, major hepatectomy, positive surgical margins, and postoperative complications were associated with an elevated risk of ER. Additionally, moderate-quality evidence suggested that elevated levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA199), lymph node metastases (LNM) of CRC, and a higher number of liver metastases were risk factors for ER.
CONCLUSIONS: This review has the potential to enhance the efficacy of surveillance strategies, refine prognostic assessments, and guide judicious treatment decisions for CRLM patients with high risk of ER. Additionally, it is essential to undertake well-designed prospective investigations to examine additional prognostic factors and develop salvage therapeutic approaches for ER of CRLM.
METHODS: Systematic searches were conducted from the inception of databases to July 14, 2023, to identify studies reporting prognostic factors associated with ER. The Quality in Prognostic Factor Studies (QUIPS) tool was employed to assess risk-of-bias for included studies. Meta-analysis was then performed on these prognostic factors, summarized by forest plots. The grading of evidence was based on sample size, heterogeneity, and Egger\'s P value.
RESULTS: The study included 24 investigations, comprising 12705 individuals, during an accrual period that extended from 2007 to 2023. In the evaluation of risk-of-bias, 22 studies were rated as low/moderate risk, while two studies were excluded because of high risk. Most of the studies used a postoperative interval of 6 months to define ER, with 30.2% (95% confidence interval [CI], 24.1-36.4%) of the patients experiencing ER following LR. 21 studies were pooled for meta-analysis. High-quality evidence showed that poor differentiation of CRC, larger and bilobar-distributed liver metastases, major hepatectomy, positive surgical margins, and postoperative complications were associated with an elevated risk of ER. Additionally, moderate-quality evidence suggested that elevated levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA199), lymph node metastases (LNM) of CRC, and a higher number of liver metastases were risk factors for ER.
CONCLUSIONS: This review has the potential to enhance the efficacy of surveillance strategies, refine prognostic assessments, and guide judicious treatment decisions for CRLM patients with high risk of ER. Additionally, it is essential to undertake well-designed prospective investigations to examine additional prognostic factors and develop salvage therapeutic approaches for ER of CRLM.
摘要：
背景：结直肠癌（CRC）是第3大最常见的恶性肿瘤，肝脏是最常见的转移部位。结直肠癌肝转移(CRLM)在肝切除术(LR)后的复发率明显较高,估计有40％的患者在6个月内复发。在这种情况下，我们进行了一项荟萃分析,以综合和评估与LR后CRLM早期复发(ER)相关预后因素相关证据的可靠性.
方法：从数据库开始到2023年7月14日进行了系统搜索，以确定报告与ER相关的预后因素的研究。采用预后因素研究质量（QUIPS）工具评估纳入研究的偏倚风险。然后对这些预后因素进行荟萃分析，按森林地块汇总。证据的分级是基于样本量，异质性，和Egger的P值。
结果：该研究包括24项调查，由12705人组成，在2007年至2023年的应计期间。在评估偏差风险时，22项研究被评为低/中度风险，而两项研究由于高风险而被排除。大多数研究使用6个月的术后间隔来定义ER，30.2%(95%置信区间[CI]，24.1-36.4％）的患者在LR后经历ER。对21项研究进行荟萃分析。高质量的证据表明，CRC的分化差，较大和双叶分布的肝转移，肝脏大切除术,手术切缘阳性,术后并发症与ER风险升高相关.此外,中等质量的证据表明，癌胚抗原（CEA）和碳水化合物抗原19-9（CA199）水平升高，CRC的淋巴结转移（LNM），和较高数量的肝转移是ER的危险因素。
结论：本综述有可能提高监测策略的有效性，完善预后评估，并指导高ER风险的CRLM患者的明智治疗决策。此外,必须进行精心设计的前瞻性研究,以检查其他预后因素,并开发CRLMER的挽救性治疗方法.
方法：从数据库开始到2023年7月14日进行了系统搜索，以确定报告与ER相关的预后因素的研究。采用预后因素研究质量（QUIPS）工具评估纳入研究的偏倚风险。然后对这些预后因素进行荟萃分析，按森林地块汇总。证据的分级是基于样本量，异质性，和Egger的P值。
结果：该研究包括24项调查，由12705人组成，在2007年至2023年的应计期间。在评估偏差风险时，22项研究被评为低/中度风险，而两项研究由于高风险而被排除。大多数研究使用6个月的术后间隔来定义ER，30.2%(95%置信区间[CI]，24.1-36.4％）的患者在LR后经历ER。对21项研究进行荟萃分析。高质量的证据表明，CRC的分化差，较大和双叶分布的肝转移，肝脏大切除术,手术切缘阳性,术后并发症与ER风险升高相关.此外,中等质量的证据表明，癌胚抗原（CEA）和碳水化合物抗原19-9（CA199）水平升高，CRC的淋巴结转移（LNM），和较高数量的肝转移是ER的危险因素。
结论：本综述有可能提高监测策略的有效性，完善预后评估，并指导高ER风险的CRLM患者的明智治疗决策。此外,必须进行精心设计的前瞻性研究,以检查其他预后因素,并开发CRLMER的挽救性治疗方法.
