文章：

结直肠腹膜转移灶减瘤手术后的全身化疗：系统综述与荟萃分析

Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis

原文发布日期：18 March 2024

DOI: 10.3390/cancers16061182

类型: Article

开放获取: 是

英文摘要：

Background. For patients with colorectal cancer (CRC) peritoneal metastases (PM) who are eligible for cytoreductive surgery (CRS), the indication and timing of systemic chemotherapy (SC) are still under debate. This study aims to analyze the role of pre, post or perioperative SC on the survival and surgical complications of patients treated with CRS-HIPEC. Methods. After a systematic search in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science and Embase, a meta-analysis was performed to compare postoperative complications, disease-free survival (DFS) and overall survival (OS) according to SC administration and timing. PROSPERO: CRD42023478977. Results. Of 1203 studies screened, 15 were included in the meta-analysis (4523 patients). Post-operative SC was associated with increased overall survival (post-SC vs. no post-SC: HR 0.81,p= 0.00001, I2= 0%; pre-SC vs. post-SC: HR 0.65,p= 0.01, I2= 28%), whereas SC (pre or post) or pre-SC compared to surgery alone was not (SC vs. no SC:p= 0.29, I2= 80%; pre-SC vs. no pre-SC:p= 0.59, I2= 58%). Similar results were seen for DFS. SC was not associated with an increased complication rate (p= 0.47, I2= 64%). Conclusions. Systemic chemotherapy administration in patients undergoing radical surgery for colorectal peritoneal metastases is associated with increased survival only in the adjuvant/post-operative setting. Considering the limitations of the included studies, further trials are needed to answer this unresolved question.

摘要翻译： 

背景：对于适合接受肿瘤细胞减灭术（CRS）的结直肠癌腹膜转移（PM）患者，全身化疗（SC）的适应症和时机仍存在争议。本研究旨在分析术前、术后或围手术期SC对接受CRS-HIPEC治疗患者的生存及手术并发症的影响。方法：通过系统检索MEDLINE、Cochrane系统评价数据库、Scopus、Web of Science和Embase，进行荟萃分析，根据SC的给药时机比较术后并发症、无病生存期（DFS）和总生存期（OS）。PROSPERO注册号：CRD42023478977。结果：在筛选的1203项研究中，15项纳入荟萃分析（共4523例患者）。术后SC与总生存期提高相关（术后SC vs. 无术后SC：HR 0.81，p=0.00001，I²=0%；术前SC vs. 术后SC：HR 0.65，p=0.01，I²=28%），而SC（术前或术后）或术前SC与单纯手术相比则无显著差异（SC vs. 无SC：p=0.29，I²=80%；术前SC vs. 无术前SC：p=0.59，I²=58%）。DFS结果相似。SC与并发症发生率增加无关（p=0.47，I²=64%）。结论：在接受根治性手术的结直肠癌腹膜转移患者中，全身化疗仅在与辅助/术后治疗联合应用时才与生存期提高相关。考虑到纳入研究的局限性，仍需进一步试验以解答这一未决问题。

原文链接：

Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis