PDF(Pubmed)
Abstract：
OBJECTIVE: The value of upfront primary tumor resection (PTR) for asymptomatic unresectable metastatic colorectal cancer (mCRC) patients remains contentious. This meta-analysis aimed to assess the prognostic significance of upfront PTR for asymptomatic unresectable mCRC.
METHODS: A systematic literature search was performed on June 21st, 2024. To minimize the bias and ensure robust evidence, only randomized controlled trials (RCTs) and case-matched studies (CMS) that compared PTR followed by chemotherapy to chemotherapy alone were included. The primary outcome was overall survival (OS), while cancer-specific survival (CSS) served as the secondary outcome.
RESULTS: Eight studies (three RCTs and five CMS) involving 1221 patients were included. Compared to chemotherapy alone, upfront PTR followed by chemotherapy did not improve OS (hazard ratios [HR] 0.91, 95% confidence interval [CI] 0.79-1.04, P = 0.17), but was associated with slightly better CSS (HR 0.59, 95% CI 0.40-0.88, P = 0.009).
CONCLUSIONS: The current limited evidence indicates that upfront PTR does not improve OS but may enhance CSS in asymptomatic unresectable mCRC patients. Ongoing trials are expected to provide more reliable evidence on this issue.
METHODS: A systematic literature search was performed on June 21st, 2024. To minimize the bias and ensure robust evidence, only randomized controlled trials (RCTs) and case-matched studies (CMS) that compared PTR followed by chemotherapy to chemotherapy alone were included. The primary outcome was overall survival (OS), while cancer-specific survival (CSS) served as the secondary outcome.
RESULTS: Eight studies (three RCTs and five CMS) involving 1221 patients were included. Compared to chemotherapy alone, upfront PTR followed by chemotherapy did not improve OS (hazard ratios [HR] 0.91, 95% confidence interval [CI] 0.79-1.04, P = 0.17), but was associated with slightly better CSS (HR 0.59, 95% CI 0.40-0.88, P = 0.009).
CONCLUSIONS: The current limited evidence indicates that upfront PTR does not improve OS but may enhance CSS in asymptomatic unresectable mCRC patients. Ongoing trials are expected to provide more reliable evidence on this issue.
摘要：
目的：对于无症状、不可切除的转移性结直肠癌（mCRC）患者，前期原发肿瘤切除（PTR）的价值仍存在争议。这项荟萃分析旨在评估早期PTR对无症状不可切除的mCRC的预后意义。
方法：6月21日进行了系统的文献检索，2024.为了最大限度地减少偏见并确保可靠的证据，仅纳入比较PTR后化疗与单纯化疗的随机对照试验(RCT)和病例匹配研究(CMS).主要结果是总生存期（OS），而癌症特异性生存率（CSS）是次要结果。
结果：纳入了涉及1221例患者的8项研究（3项RCT和5项CMS）。与单纯化疗相比，前期PTR后化疗并未改善OS（风险比[HR]0.91，95%置信区间[CI]0.79-1.04，P=0.17），但与CSS稍好相关(HR0.59,95%CI0.40-0.88,P=0.009)。
结论：目前有限的证据表明，在无症状不可切除的mCRC患者中，前期PTR并不能改善OS，但可能会增强CSS。预计正在进行的审判将为这一问题提供更可靠的证据。
方法：6月21日进行了系统的文献检索，2024.为了最大限度地减少偏见并确保可靠的证据，仅纳入比较PTR后化疗与单纯化疗的随机对照试验(RCT)和病例匹配研究(CMS).主要结果是总生存期（OS），而癌症特异性生存率（CSS）是次要结果。
结果：纳入了涉及1221例患者的8项研究（3项RCT和5项CMS）。与单纯化疗相比，前期PTR后化疗并未改善OS（风险比[HR]0.91，95%置信区间[CI]0.79-1.04，P=0.17），但与CSS稍好相关(HR0.59,95%CI0.40-0.88,P=0.009)。
结论：目前有限的证据表明，在无症状不可切除的mCRC患者中，前期PTR并不能改善OS，但可能会增强CSS。预计正在进行的审判将为这一问题提供更可靠的证据。
