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The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis

BACKGROUND: Controversy exists over the role of upfront primary tumor resection (PTR) in asymptomatic patients with unresectable stage IV colorectal cancer (CRC). The purpose of this study was to evaluate the effect of upfront PTR on survival outcomes and adverse outcomes. METHODS: Searches were con...

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Autores principales: Liang, Zongyu, Liu, Zhiyuan, Huang, Chengzhi, Chen, Xin, Zhang, Zhaojun, Xiang, Meijuan, Hu, Weixian, Wang, Junjiang, Feng, Xingyu, Yao, Xueqing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857770/
https://www.ncbi.nlm.nih.gov/pubmed/36684350
http://dx.doi.org/10.3389/fsurg.2022.1047373
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author Liang, Zongyu
Liu, Zhiyuan
Huang, Chengzhi
Chen, Xin
Zhang, Zhaojun
Xiang, Meijuan
Hu, Weixian
Wang, Junjiang
Feng, Xingyu
Yao, Xueqing
author_facet Liang, Zongyu
Liu, Zhiyuan
Huang, Chengzhi
Chen, Xin
Zhang, Zhaojun
Xiang, Meijuan
Hu, Weixian
Wang, Junjiang
Feng, Xingyu
Yao, Xueqing
author_sort Liang, Zongyu
collection PubMed
description BACKGROUND: Controversy exists over the role of upfront primary tumor resection (PTR) in asymptomatic patients with unresectable stage IV colorectal cancer (CRC). The purpose of this study was to evaluate the effect of upfront PTR on survival outcomes and adverse outcomes. METHODS: Searches were conducted on PubMed, EMBASE, Web of Science, and Cochrane Library from inception to August 2021. Studies comparing survival outcomes with or without adverse outcomes between PTR and non-PTR treatments were included. Review Manager 5.3 was applied for meta-analyses with a random-effects model whenever possible. RESULTS: Overall, 20 studies with 3,088 patients were finally included in this systematic review. Compared with non-PTR, upfront PTR was associated with better 3-year (HR: 0.69, 95% CI, 0.57–0.83, P = 0.0001) and 5-year overall survival (OS) (HR: 0.77, 95% CI, 0.62–0.95, P = 0.01), while subgroup analysis indicated that there was no significant difference between upfront PTR and upfront chemotherapy (CT) group. In addition, grade 3 or higher adverse effects due to CT were more frequent in the PTR group with marginal significance (OR: 1.74, 95% CI, 0.99–3.06, P = 0.05), and other adverse outcomes were comparable. CONCLUSIONS: PTR might be related to improved OS for asymptomatic patients with unresectable stage IV CRC, whereas receiving upfront CT is a rational alternative without detrimental influence on survival or adverse outcomes compared with upfront PTR. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272675
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spelling pubmed-98577702023-01-21 The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis Liang, Zongyu Liu, Zhiyuan Huang, Chengzhi Chen, Xin Zhang, Zhaojun Xiang, Meijuan Hu, Weixian Wang, Junjiang Feng, Xingyu Yao, Xueqing Front Surg Surgery BACKGROUND: Controversy exists over the role of upfront primary tumor resection (PTR) in asymptomatic patients with unresectable stage IV colorectal cancer (CRC). The purpose of this study was to evaluate the effect of upfront PTR on survival outcomes and adverse outcomes. METHODS: Searches were conducted on PubMed, EMBASE, Web of Science, and Cochrane Library from inception to August 2021. Studies comparing survival outcomes with or without adverse outcomes between PTR and non-PTR treatments were included. Review Manager 5.3 was applied for meta-analyses with a random-effects model whenever possible. RESULTS: Overall, 20 studies with 3,088 patients were finally included in this systematic review. Compared with non-PTR, upfront PTR was associated with better 3-year (HR: 0.69, 95% CI, 0.57–0.83, P = 0.0001) and 5-year overall survival (OS) (HR: 0.77, 95% CI, 0.62–0.95, P = 0.01), while subgroup analysis indicated that there was no significant difference between upfront PTR and upfront chemotherapy (CT) group. In addition, grade 3 or higher adverse effects due to CT were more frequent in the PTR group with marginal significance (OR: 1.74, 95% CI, 0.99–3.06, P = 0.05), and other adverse outcomes were comparable. CONCLUSIONS: PTR might be related to improved OS for asymptomatic patients with unresectable stage IV CRC, whereas receiving upfront CT is a rational alternative without detrimental influence on survival or adverse outcomes compared with upfront PTR. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272675 Frontiers Media S.A. 2023-01-06 /pmc/articles/PMC9857770/ /pubmed/36684350 http://dx.doi.org/10.3389/fsurg.2022.1047373 Text en © 2023 Liang, Liu, Huang, Chen, Zhang, Xiang, Hu, Wang, Feng and Yao. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Liang, Zongyu
Liu, Zhiyuan
Huang, Chengzhi
Chen, Xin
Zhang, Zhaojun
Xiang, Meijuan
Hu, Weixian
Wang, Junjiang
Feng, Xingyu
Yao, Xueqing
The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
title The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
title_full The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
title_fullStr The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
title_full_unstemmed The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
title_short The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis
title_sort role of upfront primary tumor resection in asymptomatic patients with unresectable stage iv colorectal cancer: a systematic review and meta-analysis
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857770/
https://www.ncbi.nlm.nih.gov/pubmed/36684350
http://dx.doi.org/10.3389/fsurg.2022.1047373
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