背景:患有无症状原发肿瘤和不可切除的结直肠癌(CRC)转移的患者是否应进行原发肿瘤切除术(PTR)仍存在争议。这项研究旨在通过评估许多结果指标来确定PTR对这些个体的适当性。
方法:进行了系统的文献检索。结果指标包括总生存率,急诊手术率,术后并发症的发生率,开始化疗的时间,转化率,和化疗相关的毒性。
结果:除化疗外接受PTR的患者总生存率优于仅接受化疗的患者(HR=0.62,95CI,0.50-0.78,I2=84%,p<0.00001)。在RCT亚组中,HR为0.72(95CI,0.45-1.13,I2=17%,p=0.15)。更多的患者在单独化疗组可以转换为可切除状态(OR=0.47,95CI,0.27-0.82,I2=0%,p=0.008),但急诊手术的发生率为23%(95CI,17-29%,I2=14%)。化疗相关毒性的风险在PTR组中没有显著升高(OR=1.5,95CI,0.94-2.43,p=0.09,I2=0%),术后并发症发生率为7%(95CI,0-14%,p=0.05,I2=0%)。PTR后开始化疗的时间约为33.06天(95CI,25.55-40.58,I2=0%)。
结论:PTR联合化疗可能与无症状结直肠癌患者合并不可切除转移的生存率提高相关。然而,PTR在RCTs亚组中没有提供显著的生存益处。此外,PTR并未显著增加化疗相关毒性的风险,术后并发症发生率约为7%,化疗可在PTR后约33.06天开始。与PTR加化疗相比,单纯化疗可显著提高转化率.然而,仅接受化疗的患者中约有23%因原发性肿瘤相关症状需要急诊手术.上述结果需要在未来更大的前瞻性随机试验中得到验证。
BACKGROUND: Whether patients with asymptomatic primary tumors and unresectable metastases of colorectal cancer (CRC) should undergo primary tumor resection (PTR) remains controversial. This study aims to determine the appropriateness of PTR for these individuals by evaluating a number of outcome measures.
METHODS: A systematic literature search was performed. Outcome measures included overall survival, emergency surgery rates, incidence of postoperative complications, time to initiate chemotherapy, conversion rates, and chemotherapy-related toxicities.
RESULTS: Patients who received PTR in addition to chemotherapy had a better overall survival rate than those who only received chemotherapy (HR = 0.62, 95%CI, 0.50-0.78, I2 = 84%, p < 0.00001). In the RCT subgroup, there were no significant differences with a HR of 0.72 (95%CI, 0.45-1.13, I2 = 17%, p = 0.15). More patients in the chemotherapy alone group could be converted to resectable status (OR = 0.47, 95%CI, 0.27-0.82, I2 = 0%, p = 0.008), but the incidence of emergency surgery was 23% (95%CI, 17-29%, I2 = 14%). The risk of chemotherapy-related toxicity was not significantly higher in the PTR group (OR = 1.5, 95%CI, 0.94-2.43, p = 0.09, I2 = 0%), with a 7% incidence of postoperative complications (95%CI, 0-14%, p = 0.05, I2 = 0%). The time to initiate chemotherapy after PTR was approximately 33.06 days (95%CI, 25.55-40.58, I2 = 0%).
CONCLUSIONS: PTR plus chemotherapy may be associated with improved survival in asymptomatic CRC patients with unresectable metastases. However, PTR did not provide a significant survival benefit in the subgroup of RCTs. Additionally, PTR did not result in a significantly increased risk of chemotherapy-related toxicity, with a postoperative complication rate of approximately 7%, and chemotherapy could be initiated at approximately 33.06 days after PTR. Compared with the PTR plus chemotherapy, chemotherapy alone could result in a significantly higher conversion rate. However, about 23% of patients receiving chemotherapy alone required emergency surgery for primary tumor-related symptoms. The above results needed to be validated in future larger prospective randomized trials.