Curative versus palliative treatments for colorectal cancer with peritoneal carcinomatosis: a systematic review and meta-analysis

Abstract

The objective of this study was to provide an up-to-date summary of the current evidence that may be useful for updating guidelines. We comprehensively searched the published literatures and conferences for studies that compared curative with palliative treatments in colorectal cancer patients with peritoneal metastasis. The primary outcomes considered in this study were three- and five-year overall survival rates. We pooled data across studies and estimated summary effect sizes. Overall, patients who received curative treatments had improved three-year survival (hazard ratio (HR), 2.19 [95% CI, 1.83 to 2.62]) and five-year survival (HR, 2.22 [95% CI, 1.83 to 2.69]) compared with those who received palliative treatments. Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% CI, 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47]). Curative treatments improved overall survival in colorectal cancer patients with peritoneal metastasis and did not increase the risk of treatment-related mortality. Curative treatments were associated with a higher risk of treatment-related morbidity. These data highlight the importance for further investigation aimed at prevention of treatment-associated morbidity.

LncRNA SNHG6 inhibits cell proliferation and metastasis by targeting ETS1 via the PI3K/AKT/mTOR pathway in colorectal cancer

“…Mature lncRNA may be located in the mRNA noncoding regions (3′-UTR or introns area) of their target gene, and may result in complete or incomplete complementary pairing, degradation or inhibition of mRNA translation and post-transcriptional alterations in gene expression. They may also participate in the regulation of cell differentiation, proliferation, apoptosis, and tissue and organ development (5,7,17).…”

“…Colorectal cancer is a malignant tumor caused by multiple factors, including individual genetics and environmental effects. For example, large-scale genetic studies have identified that the occurrence of colorectal cancer is associated with multiple genes abnormal expression and multiple molecular interactions (5–7), but the studies investigating the molecular mechanism of colorectal cancer incidence are not exhaustive. Therefore, additional studies exploring the pathogenesis of colorectal cancer may provide the theoretical basis for novel clinical anti-tumor drugs (8).…”

Colorectal peritoneal metastases: Optimal management review

“…The same systematic review[56] suggests the positive effect of adjuvant chemotherapy on overall survival, despite the heterogeneity of the studies. The most recent publications concur on reporting improvement in median survival with modern versus standard chemotherapy protocols[64], and these authors also agree on the actual approach of M1c as a curable stage for CRC[65]. The clinical value of biological therapies remains uncertain.…”

“…A large meta-analysis[65] found that intention-to-cure treatments improved overall survival in patients with CRC + PM better than palliative strategies. The risks reported have progressively decreased (recent studies report 1%-5% mortality rates at centers of excellence).…”

“…Overall survival results with this management can reach up to 62 mo if optimal cytoreduction is achieved (this means, following the cytoreduction completeness score: CCO, no tumor nodules left or CC1, implants ≤ 2.5 mm in maximum dimension)[25]. Increasing evidence from large multicenter cohort studies and some randomized controlled trials suggests that, in selected patients, CRS plus HIPEC as a combined management definitely provides improved overall and disease-free survival compared to that conferred by systemic chemotherapy alone, and possibly a major part of this benefit has to be attributed to cytoreduction[25,28,31,34,65,75] (Table 3).…”