Primary tumor resection in patients with unresectable colorectal cancer with synchronous metastases could improve the activity of poly-chemotherapy: A trial-level meta-analysis

Colloca, Giuseppe; Venturino, Antonella; Guarneri, Domenico

doi:10.1016/j.suronc.2022.101820

Cited by 7 publications

(5 citation statements)

References 63 publications

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“…Only a few studies have reported controversial results regarding the presence of tumor RAS mutations [33,51], which were related to the PTR benefits in this study. Age did not affect the benefits of PTR [24,52], whereas the female sex showed more upfront PTR benefits than the male sex, including in this study [7].…”

Section: Discussioncontrasting

confidence: 41%

“…Furthermore, there are concerns about the use of bevacizumab when the primary tumor is not resected because bevacizumab can cause bleeding, a fistula, or bowel perforation. The effect of bevacizumab administration on the PTR benefit is still controversial [7,26,28,32]. Some studies have reported that upfront PTR is associated with longer OS in bevacizumab-treated patients with CRC [26,33].…”

Section: Discussionmentioning

confidence: 99%

“…Selection bias was inevitable in cases in which upfront PTR was performed: those with a good performance status, liver-only metastasis, few organ metastases, a non-rectal origin, or low serum CEA levels [10,15,[34][35][36][37][38][39][40][41], which could have misleading results. Additionally, the study population was heterogeneous in terms of the presence of symptoms, the timing of PTR (before or during chemotherapy), and/or the application or type of systemic treatment [7][8][9][10][11][12][13]15,35,42]. To adjust for these imbalances and heterogeneity, some studies have applied statistical methods, such as multivariate analysis or propensity matching [25,42,43].…”

Section: Discussionmentioning

confidence: 99%

“…First, PTR could be associated with improved OS when performed in patients with a good performance status who can receive systemic treatment after PTR. The administration of polychemotherapy is a key determinant of OS [7]. In particular, patients receiving targeted agents showed a significantly favorable prognosis after PTR compared with the subgroup receiving chemotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective, prospective cohorts or nationwide registry analyses have shown the survival benefit of the upfront PTR in unresectable metastatic CRC [7][8][9][10][11][12][13][14][15][16]. Yet the heterogeneity of the study population, systemic treatment, and inevitable selection bias prevented definitive conclusions.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer

Shin,

An,

Shim

et al. 2023

Cancers

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The role of upfront primary tumor resection (PTR) in patients with unresectable metastatic colorectal cancer without severe symptoms remains controversial. We retrospectively analyzed the role of PTR in overall survival (OS) in this population. Among the 205 patients who enrolled, the PTR group (n = 42) showed better performance (p = 0.061), had higher frequencies of right-sided origin (p = 0.058), the T4 stage (p = 0.003), the M1a stage (p = 0.012), and <2 organ metastases (p = 0.002), and received fewer targeted agents (p = 0.011) than the chemotherapy group (n = 163). The PTR group showed a trend for longer OS (20.5 versus 16.0 months, p = 0.064) but was not related to OS in Cox regression multivariate analysis (p = 0.220). The male sex (p = 0.061), a good performance status (p = 0.078), the T3 stage (p = 0.060), the M1a stage (p = 0.042), <2 organ metastases (p = 0.035), an RAS wild tumor (p = 0.054), and the administration of targeted agents (p = 0.037), especially bevacizumab (p = 0.067), seemed to be related to PTR benefits. Upfront PTR could be considered beneficial in some subgroups, but these findings require larger studies to verify.

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer

Shin,

An,

Shim

et al. 2023

Cancers

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Development and validation of a nomogram to predict which patients with colorectal cancer liver metastases would benefit from primary tumor resection

Jia

et al. 2023

Int J Colorectal Dis

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Primary tumor resection for asymptomatic colorectal cancer patients with synchronous unresectable metastases: a meta-analysis of randomized controlled trials and case-matched studies

Huang,

Zhou,

Zhang

et al. 2024

Langenbecks Arch Surg

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Purpose The value of upfront primary tumor resection (PTR) for asymptomatic unresectable metastatic colorectal cancer (mCRC) patients remains contentious. This meta-analysis aimed to assess the prognostic significance of upfront PTR for asymptomatic unresectable mCRC. Methods A systematic literature search was performed on June 21st, 2024. To minimize the bias and ensure robust evidence, only randomized controlled trials (RCTs) and case-matched studies (CMS) that compared PTR followed by chemotherapy to chemotherapy alone were included. The primary outcome was overall survival (OS), while cancer-specific survival (CSS) served as the secondary outcome. Results Eight studies (three RCTs and five CMS) involving 1221 patients were included. Compared to chemotherapy alone, upfront PTR followed by chemotherapy did not improve OS (hazard ratios [HR] 0.91, 95% confidence interval [CI] 0.79–1.04, P = 0.17), but was associated with slightly better CSS (HR 0.59, 95% CI 0.40–0.88, P = 0.009). Conclusions The current limited evidence indicates that upfront PTR does not improve OS but may enhance CSS in asymptomatic unresectable mCRC patients. Ongoing trials are expected to provide more reliable evidence on this issue.

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Primary tumor resection in patients with unresectable colorectal cancer with synchronous metastases could improve the activity of poly-chemotherapy: A trial-level meta-analysis

Cited by 7 publications

References 63 publications

Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer

Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer

Development and validation of a nomogram to predict which patients with colorectal cancer liver metastases would benefit from primary tumor resection

Primary tumor resection for asymptomatic colorectal cancer patients with synchronous unresectable metastases: a meta-analysis of randomized controlled trials and case-matched studies

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