Abstract
The practice of adjuvant hepatic arterial infusion chemotherapy (HAIC) for colorectal liver metastasis (CRLM) varies widely. This meta-analysis investigates the effectiveness of adjuvant HAIC and the influence of variations in HAIC treatment in patients with resected CRLM. PRISMA guidelines were followed for this study. The search was limited to comparative studies (HAIC vs non-HAIC) for overall survival. Subgroup meta-analyses using random-effects were performed for type of intra-arterial drug, method of catheter insertion, use of concomitant adjuvant systemic chemotherapy, and study design. Eighteen eligible studies were identified. After excluding overlapping cohorts, fifteen studies were included in the quantitative analysis, corresponding to 3584 patients. HAIC was associated with an improved overall survival (pooled hazard ratio (HR) 0.77; 95%CI 0.64-0.93). Survival benefit of HAIC was most pronounced in studies using floxuridine (HR 0.76; 95%CI: 0.62-0.94), surgical catheter insertion with subcutaneous pump (HR 0.71; 95%CI: 0.61-0.84), and concomitant adjuvant systemic chemotherapy (HR 0.75; 95%CI: 0.59-0.96). The pooled HR of RCTs was 0.91 (95%CI 0.72-1.14), of which only 3 used floxuridine. Adjuvant HAIC is a promising treatment for patients with resectable CRLM, in particular HAIC with floxuridine using a surgically placed catheter and a subcutaneous pump, and concomitant systemic chemotherapy.
Highlights
Colorectal cancer (CRC) is the second leading cause of cancer related death worldwide.[1]
Patients with resectable colorectal liver metastasis (CRLM) may benefit from adjuvant hepatic arterial infusion chemotherapy (HAIC).[7]
The number of patients treated with HAIC ranged between 5 and 785 across studies
Summary
Colorectal cancer (CRC) is the second leading cause of cancer related death worldwide.[1]. Perioperative systemic chemotherapy is widely administered.[6] patients with resectable CRLM may benefit from adjuvant hepatic arterial infusion chemotherapy (HAIC).[7]. The practice of adjuvant hepatic arterial infusion chemotherapy (HAIC) for colorectal liver metastasis (CRLM) varies widely. This meta-analysis investigates the effectiveness of adjuvant HAIC and the influence of variations in HAIC treatment in patients with resected CRLM. Survival benefit of HAIC was most pronounced in studies using floxuridine (HR 0.76; 95%CI: 0.62–0.94), surgical catheter insertion with subcutaneous pump (HR 0.71; 95%CI: 0.61–0.84), and concomitant adjuvant systemic chemotherapy (HR 0.75; 95%CI: 0.59–0.96). Conclusion: Adjuvant HAIC is a promising treatment for patients with resectable CRLM, in particular HAIC with floxuridine using a surgically placed catheter and a subcutaneous pump, and concomitant systemic chemotherapy
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