Curative versus palliative treatments for colorectal cancer with peritoneal carcinomatosis: a systematic review and meta-analysis.

Wenqiong Wu,Lian Zhao,Zhongxi Fu,Haifang Xiao,Shipeng Yan,Xiangguo Liu,Lizhang Chen,Jinsong Mou,Xianzhen Liao,Haibo Yu

doi:10.18632/oncotarget.21912

Abstract

The objective of this study was to provide an up-to-date summary of the current evidence that may be useful for updating guidelines. We comprehensively searched the published literatures and conferences for studies that compared curative with palliative treatments in colorectal cancer patients with peritoneal metastasis. The primary outcomes considered in this study were three- and five-year overall survival rates. We pooled data across studies and estimated summary effect sizes. Overall, patients who received curative treatments had improved three-year survival (hazard ratio (HR), 2.19 [95% CI, 1.83 to 2.62]) and five-year survival (HR, 2.22 [95% CI, 1.83 to 2.69]) compared with those who received palliative treatments. Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% CI, 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47]). Curative treatments improved overall survival in colorectal cancer patients with peritoneal metastasis and did not increase the risk of treatment-related mortality. Curative treatments were associated with a higher risk of treatment-related morbidity. These data highlight the importance for further investigation aimed at prevention of treatment-associated morbidity.

Highlights

Colorectal cancer (CRC) poses an increasing threat to global health
Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% confidence intervals (CI), 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47])
We found a statistically significant improvement in short-term and long-term overall survival in those patients who received curative treatments, these treatments bear a higher risk of treatment-associated complications

Summary

Introduction

Colorectal cancer (CRC) poses an increasing threat to global health. In 2014, more than 1.4 million individuals developed CRC, and CRC-related deaths accounted for nearly 9% of the global cancer mortality burden [1]. Peritoneal carcinomatosis (PC) is a common sequela of CRC and is generally associated with limited survival [2, www.impactjournals.com/oncotarget. Median survival for most of the CRC-PC patients is only approximately 5 months. Even if palliative systemic therapy is implemented, the reported median survival time still only ranges between 5 and 15 months, which are significantly worse compared to survival times after similar therapy for other sites of CRC metastasis [10, 11, 12, 13]

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Conclusion