Meta-analysis of efficacy of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases / 国际外科学杂志

ABSTRACT

Objective:To evaluate the efficacy and safety of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases.Methods:A literature search was conducted in PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure and WanFang databases to identify studies comparing primary tumor resection and systemic treatment for asymptomatic metastatic colorectal cancer with unresectable metastases until March 31, 2021 (inchuding RCTs and non-RCTs) . The search strategy was (((colorectal cancer) OR (colorectal neoplasms) OR (colon cancer) OR (colon neoplasms) OR (rectal cancer) OR (rectal neoplasms)) AND ((metastatic) OR (stage Ⅳ)) AND (asymptomatic) AND (primary tumor resection)). Review manager (RevMan) (Version 5.3.0, Cochrane Collaboration, Oxford, UK) was used to perform the statistical analysis.Results:A total of 14 original studies (RCT 1; cohort study 13) were included in this analysis with a total of 2123 patients (primary tumor resection 1162 cases, systemic treatment 961 cases). The results of this Meta-analysis showed that PTR group had a significantly improved overall survival in 1-year overall survival ( HR=0.80, 95% CI 0.67~0.95, P=0.01), 2-year overall survival ( HR=0.81, 95% CI 0.71~0.93, P=0.002), 3-year overall survival ( HR=0.82, 95% CI 0.72~0.92, P=0.001), 4-year overall survival ( HR=0.86, 95% CI 0.75~0.98, P=0.02) and 5-year overall survival ( HR=0.85, 95% CI 0.74~0.97, P=0.02). The median survival time of PTR group was 4.35 months longer than that of systemic treatment group ( MD=4.35, 95% CI 0.99~7.72, P=0.015). Conclusions:The current evidence suggests that primary tumor resection may be a potentially safe and feasible treatment strategy for asymptomatic metastatic colorectal cancer with unresectable metastases. Large sample size prospective randomized controlled trials are needed to validate our findings in the future.