The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis.
The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis.
复制标题
新辅助化学疗法在重复复发结直肠肝转移的局部治疗中的作用：系统评价和荟萃分析。
DOI：
10.3390/cancers13030378
复制
发表时间：
2021-01-20
期刊：
影响因子：
5.2
通讯作者：
van den Tol MP
中科院分区：
文献类型：
--
作者：
Dijkstra M;Nieuwenhuizen S;Puijk RS;Geboers B;Timmer FEF;Schouten EAC;Scheffer HJ;de Vries JJJ;Ket JCF;Versteeg KS;Meijerink MR;van den Tol MP
高达85%的结直肠肝转移患者在局部治疗后发生远处肝内复发。（国际）国家指南和科学协会认为，局部重复治疗，包括重复热消融和/或重复切除，是治疗复发性新结直肠肝转移的标准护理方法。本系统综述和荟萃分析评估了重复局部治疗前新辅助化疗的潜在附加价值。虽然缺乏支持的证据，但所有作者都建议在重复局部治疗之前增加新辅助化疗。结果不支持常规使用新辅助化疗。我们目前正在构建一项III期随机对照试验，直接比较前期重复局部治疗与新辅助化疗后重复局部治疗（碰撞复发试验）。复发性结直肠癌肝转移（CRLM）患者重复局部治疗前新辅助化疗（NAC）的附加价值尚不清楚。我们在PubMed、Embase、Web of Science以及谷歌Scholar中进行了系统搜索，以找到比较局部肝部分切除术和/或热消融治疗与不进行NAC的文章。检索包括随机试验和单变量/多变量分析和/或匹配的比较观察性研究，以及使用AGREE II工具评估的（国际）国家指南。搜索确定了21832条记录；选取172篇进行全文综述；纳入20项：评估20项比较观察性研究。评价NAC在重复局部治疗前的附加价值的文献有限。NAC的结果通常以亚组分析的形式报道，结果的报道往往不明确。对有资格纳入meta分析的七项研究的评估显示出相互矛盾的结果。只有一项研究报告了在重复局部治疗之前，NAC的总生存期（OS）有显著差异。然而，进一步的分析显示，残留偏倚的风险很高，因为只有一组化疗反应者有资格进行重复局部治疗，而不考虑不符合条件的无反应者。所有特别提到复发性疾病的指南（3/3）都建议重复局部治疗；没有人对NAC的作用提出建议。本荟萃分析的不确定结果不支持在重复局部治疗之前常规支持NAC的建议。这强调了在未来的3期随机对照试验（RCT）中，有必要研究NAC在复发性CRLM患者重复局部治疗之前的附加价值。
Up to 85% of patients with colorectal liver metastases develop distant intrahepatic recurrence after curative intent local treatment. (Inter)national guidelines and scientific societies consider repeat local treatment, comprising repeat thermal ablation and/or repeat resection, the standard of care to treat recurrent new colorectal liver metastases. This systematic review and meta-analysis assessed the potential additive value of neoadjuvant chemotherapy before repeat local treatment. The addition of neoadjuvant chemotherapy prior to repeat local treatment was suggested by merely all authors, though supporting evidence is lacking. The results do not substantiate the routine use of neoadjuvant chemotherapy. We are currently constructing a phase III randomized controlled trial directly comparing upfront repeat local treatment with neoadjuvant chemotherapy followed by repeat local treatment (COLLISION RELAPSE trial). The additive value of neoadjuvant chemotherapy (NAC) prior to repeat local treatment of patients with recurrent colorectal liver metastases (CRLM) is unclear. A systematic search was performed in PubMed, Embase, Web of Science, and an additional search in Google Scholar to find articles comparing repeat local treatment by partial hepatectomy and/or thermal ablation with versus without NAC. The search included randomized trials and comparative observational studies with univariate/multivariate analysis and/or matching as well as (inter)national guidelines assessed using the AGREE II instrument. The search identified 21,832 records; 172 were selected for full-text review; 20 were included: 20 comparative observational studies were evaluated. Literature to evaluate the additive value of NAC prior to repeat local treatment was limited. Outcomes of NAC were often reported as subgroup analyses and reporting of results was frequently unclear. Assessment of the seven studies that qualified for inclusion in the meta-analysis showed conflicting results. Only one study reported a significant difference in overall survival (OS) favoring NAC prior to repeat local treatment. However, further analysis revealed a high risk for residual bias, because only a selected group of chemo-responders qualified for repeat local treatment, disregarding the non-responders who did not qualify. All guidelines that specifically mention recurrent disease (3/3) recommend repeat local treatment; none provide recommendations about the role of NAC. The inconclusive findings of this meta-analysis do not support recommendations to routinely favor NAC prior to repeat local treatment. This emphasizes the need to investigate the additive value of NAC prior to repeat local treatment of patients with recurrent CRLM in a future phase 3 randomized controlled trial (RCT).
登录
查看更多内容
影响因子：
--
作者：
Gleisner, Ana L.;Choti, Michael A.;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
3.8
作者：
Hackl C;Neumann P;Gerken M;Loss M;Klinkhammer-Schalke M;Schlitt HJ
通讯作者：
Schlitt HJ
影响因子：
3.8
作者：
Creasy JM;Sadot E;Koerkamp BG;Chou JF;Gonen M;Kemeny NE;Balachandran VP;Kingham TP;DeMatteo RP;Allen PJ;Blumgart LH;Jarnagin WR;D'Angelica MI
通讯作者：
D'Angelica MI
影响因子：
3.8
作者：
Engstrand J;Nilsson H;Strömberg C;Jonas E;Freedman J
通讯作者：
Freedman J
影响因子：
9
作者：
Adam, R;Bismuth, H;Engerran, L
通讯作者：
Engerran, L