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中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 305 -310. doi: 10.3877/cma.j.issn.1674-3946.2023.03.019

论著

转移灶不可切除的无症状结直肠癌是否行原发灶肿瘤切除术的Meta分析
张成仁1, 杨熊飞2, 杜斌斌2,(), 柳利利3, 李晶晶2, 朱成章2, 吴德望2, 吕耀春2,()   
  1. 1. 730000 兰州,甘肃省人民医院肛肠科;730000 兰州,甘肃省肛肠疾病临床医学研究中心;750000 宁夏银川,宁夏医科大学临床医学院
    2. 730000 兰州,甘肃省肛肠疾病临床医学研究中心;750000 宁夏银川,宁夏医科大学临床医学院
    3. 730000 兰州,甘肃省肛肠疾病临床医学研究中心
  • 收稿日期:2022-12-18 出版日期:2023-06-26
  • 通信作者: 杜斌斌, 吕耀春

A meta-analysis of primary tumor resection in asymptomatic colorectal cancer with unresectable metastases

Chengren Zhang1, Xiongfei Yang2, Binbin Du2,(), Lili Liu3, Jingjing Li2, Chengzhang Zhu2, Dewang Wu2, Yaochun Lv2,()   

  1. 1. Department of Anorectal Surgery,Gansu Provincial People’s Hospital,Lanzhou Gansu Province 730000,China
    2. Clinical Research Center for Anorectal Diseases of Gansu Province,Lanzhou Gansu Province 730000,China
  • Received:2022-12-18 Published:2023-06-26
  • Corresponding author: Binbin Du, Yaochun Lv
  • Supported by:
    Key Research and Development Program of Science and Technology Department of Gansu Province(22YF7FA097); Science and Technology Development Program of Lanzhou Science and Technology Bureau(2022-5-51); Gansu Clinical Medical Research Center for Anorectal Diseases(20JR10RA434); Scientific Research Fund of Gansu Provincial People’s Hospital(21GSSYC-20, 21GSSYC-21); Foundation of Lanzhou Science and Technology Bureau(2022-ZD-47)
引用本文:

张成仁, 杨熊飞, 杜斌斌, 柳利利, 李晶晶, 朱成章, 吴德望, 吕耀春. 转移灶不可切除的无症状结直肠癌是否行原发灶肿瘤切除术的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 305-310.

Chengren Zhang, Xiongfei Yang, Binbin Du, Lili Liu, Jingjing Li, Chengzhang Zhu, Dewang Wu, Yaochun Lv. A meta-analysis of primary tumor resection in asymptomatic colorectal cancer with unresectable metastases[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(03): 305-310.

目的

评估原发灶肿瘤切除(PTR)加化疗对比单纯化疗治疗转移灶不可切除无症状结直肠癌患者的疗效。

方法

检索从数据库建立至2022年10月发表在PubMed、Embase、Web of science、Cochrane Library、中国知网、万方以及维普等数据库中的相关研究,采用Review Manager 5.4软件以及Stata 16.0软件进行生存资料的Meta分析。以HR及其95%CI来评估患者的生存风险,采用Q检验及I2检验来评估研究之间异质性大小,采用敏感性分析评估结果的可靠性,采用亚组分析寻找异质性的来源,采用Egger's检验以及漏斗图评估研究之间发表偏倚。

结果

共纳入10项研究,包括5项随机对照试验(RCT)和5项回顾性队列研究(RCS)。Meta分析结果显示患者总生存率(OS)和无进展生存期(PFS)在两种治疗方式之间差异无统计学意义;亚组分析的结果同样提示PTR并没有给患者带来额外的生存获益。漏斗图以及Egger's检验的结果(t=-0.360,P=0.730)表明报道患者OS的研究无明显发表偏倚。

结论

PTR加化疗相对于单纯化疗不能给患者带来更多的生存获益,但鉴于本研究的局限性,仍需要后续大样本随机对照试验进行验证。

Objective

To evaluate the efficacy of primary tumor resection(PTR)plus chemotherapy versus chemotherapy alone in patients with unresectable asymptomatic colorectal cancer with metastases.

Methods

To search relevant studies published in PubMed,Embase,Web of science,Cochrane Library,CNKI,Wanfang and VIP databases from the establishment of the database to October 2022. Meta analysis of survival data was performed by Review Manager 5.4 and Stata 16.0. HR and its 95% CI were used to evaluate the survival risk of patients,Q test and I2 test were used to evaluate the heterogeneity between studies,sensitivity analysis was used to evaluate the reliability of the results,subgroup analysis was used to find the source of heterogeneity,and Egger's test and funnel plot were used to evaluate publication bias between studies.

Results

A total of 10 studies were included,including 5 randomized controlled trials(RCTS)and 5 retrospective cohort studies(RCS). Meta-analysis showed no significant differences in overall survival(OS)and progression-free survival(PFS)between the two treatments. The results of subgroup analysis also suggested no additional survival benefit from PTR. The results of funnel plot and Egger's test(t=-0.360,P=0.730)showed that there was no significant publication bias in the studies reporting patients' OS.

Conclusions

Compared with chemotherapy alone,PTR plus chemotherapy can not bring more survival benefits to patients. However,due to the limitations of this study,follow-up large-sample randomized controlled trials are still needed for verification.

图1 原发灶无症状且转移灶不可切除的结直肠癌患者文献筛选流程及结果
表1 纳入10项研究中的结直肠癌患者PTR组与化疗组基本特征比较
作者及年份 国家

研究

类型

样本量(n) 年龄(岁) 性别(男/女)
PTR 化疗 PTR 化疗 PTR 化疗
Kanemitsu等[15]2021 日本 RCT 81 84 65(59~69) 65(59~71) 45/39 45/36
Huang等 [16]2022 中国 RCT 42 44 57(32~73) 60(22~73) 26/16 25/19
Park等[17]2020 韩国 RCT 26 22 62.3±11.8 58.8±12.1 21/5 12/10
Ferrand等[18]2013 法国 RCT 156 60 64±8.2 62±10 96/60 44/16
Rahbari等[19]2022 德国 RCT 187 206 - - - -
Samalavicius等[20] 2016 立陶宛 RCS 120 63 66(37~91) 67/53 37/26
Watanabe等[21]2014 日本 RCS 46 112 63(41~81) 60(27~80) 25/21 71/41
Doah等[22]2021 韩国 RCS 98 48 69(58~77) 66.5(62~75) 49/49 29/19
Yun等[4]2014 韩国 RCS 218 198 58(23~87) 59(25~77) 141/77 130/68
Matsumoto等[23]2014 日本 RCS 41 47 67(59~72) 62(57~68) 25/16 33/14
作者及年份 肿瘤位置 转移位置(PTR/化疗)

随访时间

(月)

结局指标 质量评价
肝(%) 肺(%) 淋巴结(%)
Kanemitsu等[15]2021 结直肠 74/71 27/21 20/27 22 OS、PFS Jadad 6
Huang等[16]2022 结肠 38/30 2/7 - 15 OS、PFS Jadad 4
Park等[17]2020 结直肠 61.5/50 7.7/4.5 7.7/0 15 OS Jadad 3
Ferrand等[18]2013 结直肠 62/53 - - 33 OS、PFS Jadad 4
Rahbari等[19]2022 结肠 - - - 36.7 OS - -
Samalavicius等[20] 2016 结直肠 85/73 57.6/23.8 16/16 - OS NOS 6
Watanabe等[21]2014 结直肠 74/83 39/31 30/47 26 OS NOS 8
Doah等[22]2021 结直肠 73.5/64.6 37.8/35.4 17.3/31.2 - OS NOS 6
Yun等[4]2014 结直肠 85/88.5 28.3/29.2 8/6.2 22 OS NOS 8
Matsumoto等[23]2014 结直肠 48.8/53.2 34.2/38.4 17.2/6.4 21 OS NOS 7
图2 纳入10项研究的结直肠癌患者PTR组与化疗组总生存率(OS)的Meta分析结果
图3 纳入10项研究的结直肠癌患者PTR组与化疗组PFS 的Meta分析结果
图4 原发灶无症状且转移灶不可切除的结直肠癌患者总生存率(OS)的漏斗图注:LN-HR=HR的对数;seLN-HR=HR对数的标准误。
[1]
Ergun YBal ODogan M,et al. Does primary tumor resection contribute to overall survival in unresectable synchronous metastatic colorectal cancer?[J]. J Res Med Sci202025:14.
[2]
Arhin NDShen CBailey CE,et al. Surgical resection and survival outcomes in metastatic young adult colorectal cancer patients[J]. Cancer Med202110(13):4269-4281.
[3]
Pędziwiatr MMizera MWitowski J,et al. Primary tumor resection in stage Ⅳ unresectable colorectal cancer:what has changed?[J]. Med Oncol201734(12):188.
[4]
Yun JAHuh JWPark YA,et al. The Role of Palliative Resection for Asymptomatic Primary Tumor in Patients With Unresectable Stage Ⅳ Colorectal Cancer[J]. Dise Colon Rectum201457(9):1049-1058.
[5]
Ha GWKim JHLee MR. Meta-analysis of oncologic effect of primary tumor resection in patients with unresectable stage Ⅳ colorectal cancer in the era of modern systemic chemotherapy[J]. Ann Surg Treat Res201895(2):64-72.
[6]
Moher DLiberati ATetzlaff J,et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement[J]. PLoS Med20096(7):e1000097.
[7]
Lo CKMertz DLoeb M. Newcastle-Ottawa Scale:comparing reviewers' to authors' assessments[J]. BMC Med Res Methodol201414:45.
[8]
Jadad ARMoore RACarroll D,et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials199617(1):1-12.
[9]
Parmar MKTorri VStewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints[J]. Stat Med199817(24):2815-2834.
[10]
Higgins JPThompson SGDeeks JJ,et al. Measuring inconsistency in meta-analyses[J]. BMJ2003327(7414):557-560.
[11]
Patsopoulos NAEvangelou EIoannidis JP. Sensitivity of between-study heterogeneity in meta-analysis:proposed metrics and empirical evaluation[J]. Int J Epidemiol200837(5):1148-1157.
[12]
Duval STweedie R. Trim and fill:A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis[J]. Biometrics200056(2):455-463.
[13]
Egger MDavey Smith GSchneider M,et al. Bias in meta-analysis detected by a simple,graphical test[J]. BMJ1997315(7109):629-634.
[14]
Sutton AJDuval SJTweedie RL,et al. Empirical assessment of effect of publication bias on meta-analyses[J]. BMJ2000320(7249):1574-1577.
[15]
Kanemitsu YShitara KMizusawa J,et al. Primary Tumor Resection Plus Chemotherapy Versus Chemotherapy Alone for Colorectal Cancer Patients With Asymptomatic,Synchronous Unresectable Metastases(JCOG1007;iPACS):A Randomized Clinical Trial[J]. J Clin Oncol202139(10):1098-1107.
[16]
Huang MYang YLi Q,et al. Induction Chemotherapy Followed by Primary Tumor Resection Did Not Bring Survival Benefits in Colon Cancer Patients With Asymptomatic Primary Lesion and Synchronous Unresectable Metastases[J]. Front Oncol202212:747124.
[17]
Park EJBaek JHChoi GS,et al. The Role of Primary Tumor Resection in Colorectal Cancer Patients with Asymptomatic,Synchronous,Unresectable Metastasis:A Multicenter Randomized Controlled Trial[J]. Cancers202012(8):2306.
[18]
Ferrand FMalka DBourredjem A,et al. Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy:results from the multicenter,randomised trial Fédération Francophone de Cancérologie Digestive 9601[J]. Eur J Cancer201349(1):90-97.
[19]
Rahbari NNLordick FFink C,et al. Resection of the primary tumour versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases(UICC stage Ⅳ):SYNCHRONOUS--a randomised controlled multicentre trial(ISRCTN30964555)[J]. BMC Cancer201212:142.
[20]
Samalavicius NEDulskas ABaltruskeviciene E,et al. Asymptomatic primary tumour in incurable metastatic colorectal cancer:is there a role for surgical resection prior to systematic therapy or not?[J]. Wideochir Inne Tech Maloinwazyjne201611(4):274-282.
[21]
Watanabe AYamazaki KKinugasa Y,et al. Influence of primary tumor resection on survival in asymptomatic patients with incurable stage Ⅳ colorectal cancer[J]. Int J Clin Oncol201419(6):1037-1042.
[22]
Doah KYShin USJeon BH,et al. The Impact of Primary Tumor Resection on Survival in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases[J]. Ann Coloproctol202137(2):94-100.
[23]
Matsumoto THasegawa SMatsumoto S,et al. Overcoming the challenges of primary tumor management in patients with metastatic colorectal cancer unresectable for cure and an asymptomatic primary tumor[J]. Dis Colon Rectum201457(6):679-686.
[24]
Tappenden PJones RPaisley S,et al. Systematic review and economic evaluation of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer[J]. Health Technol Assess200711(12):1-128,iii-iv.
[25]
Golfinopoulos VSalanti GPavlidis N,et al. Survival and disease-progression benefits with treatment regimens for advanced colorectal cancer:a meta-analysis[J]. Lancet Oncol20078(10):898-911.
[26]
Hochster HSHart LLRamanathan RK,et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer:results of the TREE Study[J]. J Clin Oncol200826(21):3523-3529.
[27]
邵永孚,吴铁成. 无法治愈的结直肠癌的姑息性外科治疗[J/CD]. 中华普外科手术学杂志(电子版),20104(01):25-27.
[28]
Simillis CKalakouti EAfxentiou T,et al. Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer:A Systematic Review and Meta-analysis[J]. World J Surg201943(7):1829-1840.
[29]
Lee KCOu YCHu WH,et al. Meta-analysis of outcomes of patients with stage Ⅳ colorectal cancer managed with chemotherapy/radiochemotherapy with and without primary tumor resection[J]. Onco Targets Ther20169:7059-7069.
[30]
Ha GWKim JHLee MR. Meta-analysis of oncologic effect of primary tumor resection in patients with unresectable stage Ⅳ colorectal cancer in the era of modern systemic chemotherapy[J]. Ann Surg Treat Res201895(2):64-72.
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