Ann Surg Treat Res.  2018 Aug;95(2):64-72. 10.4174/astr.2018.95.2.64.

Meta-analysis of oncologic effect of primary tumor resection in patients with unresectable stage IV colorectal cancer in the era of modern systemic chemotherapy

• Ha GW
• Kim JH
• Lee MR

• KMID: 2417771
• DOI: http://doi.org/10.4174/astr.2018.95.2.64

Abstract

PURPOSE
The management of primary tumors in patients with stage IV colorectal cancer remains unclear. This meta-analysis evaluated the survival benefits of primary tumor resection (PTR) in patients with unresectable stage IV colorectal cancer in the era of modern chemotherapy.
METHODS
Multiple comprehensive databases were searched for studies comparing survival outcomes in patients with metastatic colorectal cancer who did and did not undergo PTR. Outcome data were pooled, and overall effect size was calculated using random effect models.
RESULTS
Seventeen nonrandomized studies involving 18,863 patients met the inclusion criteria. Meta-analysis showed that PTR significantly improved overall survival (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.56-0.71; P < 0.001) and progression free survival (HR, 0.76; 95% CI, 0.67-0.87; P < 0.001). Subgroup analyses and sensitivity analyses, performed by predefined methods, also indicated that PTR improved overall patient survival.
CONCLUSION
Palliative resection of the primary tumor may have survival benefits in patients with unresectable stage IV colorectal cancer. Randomized controlled trials are needed to determine the optimal treatment for these patients.

Keyword

Colorectal neoplasms; Palliative care; Colorectal surgery; Prognosis; Survival

MeSH Terms

Colorectal Neoplasms*
Colorectal Surgery
Disease-Free Survival
Drug Therapy*
Humans
Palliative Care
Prognosis

Figure

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  Fig. 1 Flow chart of the literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.

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  Fig. 2 Forest plot and meta-analysis of the effects of primary tumor resection on overall survival. SE, standard error; CI, confidence interval; df, degree of freedom.

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  Fig. 3 Forest plot and meta-analysis of the effects of primary tumor resection on progression-free survival. SE, standard error; CI, confidence interval; df, degree of freedom.

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  Fig. 4 Funnel plots of included studies in the analysis for the effects of primary tumor resection on overall survival. SE, standard error.

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