Abstract
Neoadjuvant chemotherapy is being increasingly accepted as an effective treatment of resectable colorectal liver metastases (CRLM), but it may also damage the hepatic parenchyma. We performed a meta-analysis to compare the outcomes of patients who received neoadjuvant chemotherapy (NEO) prior to hepatic resection with hepatic resection without neoadjuvant chemotherapy (SG). Eligible trials were identified from Embase, PubMed, the Web of Science and the Cochrane library. Hazard ratios (HRs) with a 95% confidence intervals (CIs) were used to measure the pooled effect using a random-effects model. Statistical heterogeneity was detected by I2 test. Sensitivity analyses and publication bias were also assessed. The study outcomes included 3-year, 5-year disease-free and overall survival rate, respectively. Eighteen studies involving 6,254 patients were included. The pooled HRs for 5-year DFS and 5-year OS for NEO in the included studies calculated using the random-effects model were 1.38 (95 % CI; 1.26-1.51, p=0.00; I2=9.6%, p=0.36) and 1.19 (95% CI: 1.02-1.38; p=0.03; I2=49.2%, p=0.03), respectively. For CRLM patients with factors indicating a high risk of recurrence, the pooled HR for 5-year OS of NEO in the included studies calculated using the random-effects model was 0.69 (95% CI: 0.55-0.87; p=0.00; I2=0.0%, p=0.48). These results suggest neoadjuvant chemotherapy improved survival of patients with initially resectable CRLM and a high risk of disease recurrence.
Highlights
Colorectal cancer (CRC) is the third most common cause of cancer-related deaths [1]
Included studies fulfilled the following criteria: (1) the study population were adults diagnosed with resectable colorectal liver metastases (CRLM); (2) the intervention was neoadjuvant chemotherapy administered prior to hepatic resection; (3) results were compared with patients undergoing hepatic resection without neoadjuvant chemotherapy; (4) outcomes included characteristics, overall survival (OS), disease-free survival (DFS), treatment-related complications and R1 resection rate
The articles excluded from the analysis included (1) comments, editorials, systematic reviews and studies unrelated to our topics were excluded from the final analysis; (2) those that included patients with initially unresectable metastases; and (3) those in which the outcomes were not reported or were impossible to calculate for both groups
Summary
Colorectal cancer (CRC) is the third most common cause of cancer-related deaths [1]. Metastasis is the major reason of mortality in CRC patients, with the liver being the only site of metastases in approximately 30% of the patients. Hepatic resection remains a well-accepted treatment modality for patients with colorectal liver metastases (CRLM ) and is associated with 5-year survival rate ranging from 37% to 58% [2, 3]. Consistent with that idea, a recent review of 23 studies involving over 3,000 patients showed a benefit from neoadjuvant chemotherapy [4]. It has been proposed neoadjuvant chemotherapy could be an effective component of individualized precision medicine for CRLM patients at high risk of disease recurrence.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
