■对于至少一次先前的全身治疗失败的不可切除的结直肠肝转移(CRLM)患者,不同治疗方法之间的比较结果有限。我们旨在通过这项调查比较这些患者的全身治疗的疗效。
■我们收集了截至2023年7月以英文报道的随机对照试验(RCT),来自包括PubMed在内的数据库,Embase,科克伦图书馆,ClinicalTrials.gov,和著名的会议数据库,用于此贝叶斯网络荟萃分析。包括评估至少两种治疗方案的II期或III期试验。主要结果是总生存期(OS),次要结局是无进展生存期(PFS).使用具有95%置信区间(CI)的风险比(HR)作为效应大小。根据转移部位进行亚组分析。当前的系统审查方案已在PROSPERO(CRD42023420498)上注册。
■包括30个RCT,共有13,511名患者。与化疗相比,多靶向治疗(HR0.57,95%CI0.37-0.87)和靶向治疗加化疗(HR0.78,95%CI0.67-0.91)显示出显著优势.靶向治疗(HR0.92,95%CI0.54-1.57)和局部治疗加化疗(HR1.03,95%CI0.85-1.23)具有相当的性能。对于肝转移患者,TAS-102加贝伐单抗,阿柏西普联合氟尿嘧啶联合化疗(CTFU),贝伐单抗联合卡培他滨联合化疗(CTCA)在OS方面显示最佳结局.贝伐单抗加强化CTFU,贝伐单抗加CTCA,HAI和单药化疗(SingleCT)在PFS方面表现最好。对于肝脏受限转移的患者,aflibercept加CTFU是操作系统中的最佳选择。对于PFS,最好的选择是HAI,其次是SingleCT,aflibercept加CTFU,和帕尼单抗联合CTFU。对于有多部位转移的患者,最好的治疗方法是TAS-102加贝伐单抗,贝伐单抗加CTCA,贝伐单抗加CTFU,和aflibercept加CTFU。
■多靶向治疗和靶向治疗加化疗是最好的治疗机制。TAS-102加贝伐单抗在OS上更优越,贝伐单抗和阿柏西普等抗VEGF药物联合标准化疗是CRLM患者的首选方案.
UNASSIGNED: There is limited evidence of comparative results among different treatments for patients with unresectable colorectal liver metastases (CRLM) who have failed at least one line of previous systemic therapy. We aimed to compare the efficacy of systemic treatments among these patients through this investigation.
UNASSIGNED: We collected randomized controlled trials (RCTs) reported in English up until July 2023, from databases including PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and prominent conference databases, for this Bayesian network meta-analysis. Phase II or III trials that evaluated at least two therapeutic regimens were included. Primary outcome was overall survival (OS), secondary outcome was progression-free survival (PFS). Hazards ratios (HRs) with 95% confidence intervals (CIs) were used as effect size. Subgroup analysis was performed based on metastatic sites. The current systematic review protocol was registered on PROSPERO (CRD42023420498).
UNASSIGNED: 30 RCTs were included, with a total of 13,511 patients. Compared to chemotherapy, multi-targeted therapy (HR 0.57, 95% CI 0.37-0.87) and targeted therapy plus chemotherapy (HR 0.78, 95% CI 0.67-0.91) show significant advantages. Targeted therapy (HR 0.92, 95% CI 0.54-1.57) and local treatment plus chemotherapy (HR 1.03, 95% CI 0.85-1.23) had comparable performance. For patients with liver metastases, TAS-102 plus bevacizumab, aflibercept plus fluorouracil-based combination chemotherapy (CTFU), and bevacizumab plus capecitabine-based combination chemotherapy (CTCA) showed the best outcomes in terms of OS. Bevacizumab plus intensified CTFU, bevacizumab plus CTCA, and HAI followed by single-agent chemotherapy (SingleCT) performed the best regarding PFS. For patients with liver-limited metastases, aflibercept plus CTFU is the optimal choice in OS. For PFS, the best options were HAI followed by SingleCT, aflibercept plus CTFU, and panitumumab plus CTFU. For patients with multiple-site metastases, the best treatments were TAS-102 plus bevacizumab, bevacizumab plus CTCA, bevacizumab plus CTFU, and aflibercept plus CTFU.
UNASSIGNED: Multi-targeted therapy and targeted therapy plus chemotherapy are the best treatment mechanisms. TAS-102 plus bevacizumab is superior in OS, the combination of anti-VEGF drugs like bevacizumab and aflibercept with standard chemotherapy is the preferred option for CRLM patients.