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Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases

There are 5 major adjuvant chemotherapies (ACTs) for hepatic metastases for colorectal cancer; however, the optimal treatment regimen remains inconclusive. Here, we aim to compare these therapies in terms of patient survival rate, intrahepatic recurrence rate, and adverse events. Different databases...

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Autores principales: Zhu, Gui-Qi, You, Jie, Shi, Ke-Qing, He, Sun-Yue, Wang, Li-Ren, Chen, Yong-Ping, Braddock, Martin, Zheng, Ming-Hua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602852/
https://www.ncbi.nlm.nih.gov/pubmed/25569666
http://dx.doi.org/10.1097/MD.0000000000000379
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author Zhu, Gui-Qi
You, Jie
Shi, Ke-Qing
He, Sun-Yue
Wang, Li-Ren
Chen, Yong-Ping
Braddock, Martin
Zheng, Ming-Hua
author_facet Zhu, Gui-Qi
You, Jie
Shi, Ke-Qing
He, Sun-Yue
Wang, Li-Ren
Chen, Yong-Ping
Braddock, Martin
Zheng, Ming-Hua
author_sort Zhu, Gui-Qi
collection PubMed
description There are 5 major adjuvant chemotherapies (ACTs) for hepatic metastases for colorectal cancer; however, the optimal treatment regimen remains inconclusive. Here, we aim to compare these therapies in terms of patient survival rate, intrahepatic recurrence rate, and adverse events. Different databases were searched for controlled trials up to June 30, 2014. The pooled hazards ratios for death and odds ratios (ORs) for intrahepatic recurrence and adverse events were estimated. A mean ranking and the probability of optimal therapeutic regime was obtained for each treatment analyzed in the network meta-analysis. Eleven eligible articles were included. Systemic chemotherapy (SCT) was ranked the most efficacious intervention among ACTs in both 1-year and 5-year survival; however, no statistical difference could be determined. Combination of bevacizumab (BEV) and hepatic arterial infusion (HAI) plus SCT was the most effective in preventing intrahepatic recurrence when compared with HAI alone (OR 1.21, 95% confidence interval [CI] 0.01–131.12), SCT (OR 2.37, 95% CI 0.03–234.16), HAI plus SCT (OR 0.97, 95% CI 0.03–35.30), SCT plus irinotecan (OR 1.01, 95% CI 0.00–278.14) and observation alone (OR 0.83, 95% CI 0.01–59.53). BEV and HAI plus SCT provided the least survival benefit after both 1 and 5 years compared with remaining therapies, and also was ranked the regiment with the least favorable adverse event profile among ACTs. SCT may be the most efficacious intervention, however, the potential benefit should be carefully considered with the regime's associated toxicities. Combination of BEV and HAI plus SCT was effective in preventing intrahepatic relapse but was associated with the highest risk for adverse events in patients with resected hepatic metastases for colorectal cancer.
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spelling pubmed-46028522015-10-27 Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases Zhu, Gui-Qi You, Jie Shi, Ke-Qing He, Sun-Yue Wang, Li-Ren Chen, Yong-Ping Braddock, Martin Zheng, Ming-Hua Medicine (Baltimore) 4500 There are 5 major adjuvant chemotherapies (ACTs) for hepatic metastases for colorectal cancer; however, the optimal treatment regimen remains inconclusive. Here, we aim to compare these therapies in terms of patient survival rate, intrahepatic recurrence rate, and adverse events. Different databases were searched for controlled trials up to June 30, 2014. The pooled hazards ratios for death and odds ratios (ORs) for intrahepatic recurrence and adverse events were estimated. A mean ranking and the probability of optimal therapeutic regime was obtained for each treatment analyzed in the network meta-analysis. Eleven eligible articles were included. Systemic chemotherapy (SCT) was ranked the most efficacious intervention among ACTs in both 1-year and 5-year survival; however, no statistical difference could be determined. Combination of bevacizumab (BEV) and hepatic arterial infusion (HAI) plus SCT was the most effective in preventing intrahepatic recurrence when compared with HAI alone (OR 1.21, 95% confidence interval [CI] 0.01–131.12), SCT (OR 2.37, 95% CI 0.03–234.16), HAI plus SCT (OR 0.97, 95% CI 0.03–35.30), SCT plus irinotecan (OR 1.01, 95% CI 0.00–278.14) and observation alone (OR 0.83, 95% CI 0.01–59.53). BEV and HAI plus SCT provided the least survival benefit after both 1 and 5 years compared with remaining therapies, and also was ranked the regiment with the least favorable adverse event profile among ACTs. SCT may be the most efficacious intervention, however, the potential benefit should be carefully considered with the regime's associated toxicities. Combination of BEV and HAI plus SCT was effective in preventing intrahepatic relapse but was associated with the highest risk for adverse events in patients with resected hepatic metastases for colorectal cancer. Wolters Kluwer Health 2015-01-09 /pmc/articles/PMC4602852/ /pubmed/25569666 http://dx.doi.org/10.1097/MD.0000000000000379 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0
spellingShingle 4500
Zhu, Gui-Qi
You, Jie
Shi, Ke-Qing
He, Sun-Yue
Wang, Li-Ren
Chen, Yong-Ping
Braddock, Martin
Zheng, Ming-Hua
Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases
title Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases
title_full Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases
title_fullStr Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases
title_full_unstemmed Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases
title_short Systematic Review With Network Meta-Analysis: Adjuvant Chemotherapy for Resected Colorectal Liver Metastases
title_sort systematic review with network meta-analysis: adjuvant chemotherapy for resected colorectal liver metastases
topic 4500
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602852/
https://www.ncbi.nlm.nih.gov/pubmed/25569666
http://dx.doi.org/10.1097/MD.0000000000000379
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