Chemotherapy for Patients with Colorectal Liver Metastases Who Underwent Curative Resection Improves Long-Term Outcomes: Systematic Review and Meta-analysis

Background Hepatic resection is considered the standard of care for patients with resectable colorectal liver metastases (CRLM), but the benefits of using systemic chemotherapy for these patients have not been completely proven. Although systemic chemotherapy is likely to improve recurrence-free sur...

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Bibliographic Details
Published in:Annals of Surgical Oncology 2015-09, Vol.22 (9), p.3070-3078
Main Authors: Araujo, Raphael L. C., Gönen, Mithat, Herman, Paulo
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Colorectal Neoplasms - drug therapy
Colorectal Neoplasms - mortality
Colorectal Neoplasms - pathology
Colorectal Neoplasms - surgery
Combined Modality Therapy
Hepatectomy - mortality
Hepatobiliary Tumors
Humans
Liver Neoplasms - drug therapy
Liver Neoplasms - mortality
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Medicine
Medicine & Public Health
Neoplasm Staging
Oncology
Prognosis
Surgery
Surgical Oncology
Survival Rate
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Summary:Background Hepatic resection is considered the standard of care for patients with resectable colorectal liver metastases (CRLM), but the benefits of using systemic chemotherapy for these patients have not been completely proven. Although systemic chemotherapy is likely to improve recurrence-free survival (RFS), no differences in overall survival (OS) have been demonstrated to date. This study aimed to compare surgery plus systemic chemotherapy, regardless timing of administration, with surgery alone, analyzing long-term outcomes for patients with CRLM who underwent liver resection with curative intent. Methods Systematic review and meta-analysis of studies published from January 1991 to December 2013 were used to compare surgery alone and surgery plus chemotherapy for patients with CRLM who underwent liver resection with curative intent. All randomized clinical trials (RCTs) were included in the study. Selection of high-quality observational comparative studies (OCSs) was based on a validated tool, the Methodological Index for Nonrandomized Studies. Comparison of RFS and OS was performed using a fixed-effects model and the hazard ratio (HR). Results Concerning OS, 5 studies (3 RCTs and 2 OCSs) comprising 2,475 patients were analyzed, and chemotherapy (1,024 patients) relatively improved OS rates for 23 % of the patients versus surgery alone (HR, 0.77; 95 % confidence interval [CI] 0.67–0.88; p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-014-4354-6