Multimodal treatment improves survival in patients with lung metastases from colorectal cancer: A network meta-analysis

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-01-22 DOI:10.1111/codi.70002

Andrea Chierici, Danilo Vinci, Guido Liddo, Stefano Granieri, Mauro Loi, Marco Alifano, Antonio Iannelli

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Abstract

Aim

The lungs represent the second most common site of colorectal cancer metastases. Although surgery is commonly considered the best treatment, many other invasive and noninvasive procedures and treatments have been adopted to improve patient survival and there is no clear evidence in the literature of which is the more effective. The aim of this work was to identify which treatment confers the best gain in overall survival for patients with pulmonary metastases from colorectal cancer.

Method

A systematic review and network meta-analysis of survival hazard ratio (HR) including 11 studies was conducted following the PRISMA guidelines and the Cochrane protocol on PubMed, Scopus, Embase, Web of Science and Cochrane Library up to 31 December 2023. Surgery, image-guided thermoablation, stereotactic body radiotherapy, chemotherapy and best standard care, associated or alone, were evaluated. Chemotherapy was adopted as the treatment reference to define survival HRs. Network metaregression was then performed considering patients with pulmonary only or multisite metastases from colorectal cancer.

Results

In patients with pulmonary metastases, the association of surgery, stereotactic body radiotherapy and chemotherapy is the best performing (HR 0.22), while the most effective components alone are image-guided thermoablation (HR 0.53) and surgery (HR 0.57), although this was not significant. After metaregression, multimodal treatments still represent the strategy conferring the best survival gain. However, while surgery (incremental HR 0.26) has the most important role in patients with isolated pulmonary metastatic disease, chemotherapy (incremental HR 0.3) leads for patients with multimetastatic disease.

Conclusion

Multimodal treatment confers the best gain in overall survival in patients with pulmonary metastases from colorectal cancer. Combining multiple therapeutic strategies improves survival, with oligometastatic patients benefiting more from surgery and local therapies while multimetastatic patients mainly benefit from chemotherapy, although ablation and surgery can enhance outcomes when feasible.

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多模式治疗提高结直肠癌肺转移患者的生存率：一项网络荟萃分析。

目的：肺是结直肠癌转移的第二大常见部位。虽然手术通常被认为是最好的治疗方法，但许多其他侵入性和非侵入性的手术和治疗方法被采用来提高患者的生存率，并且在文献中没有明确的证据表明哪一种更有效。这项工作的目的是确定哪种治疗方法可以为结直肠癌肺转移患者提供最佳的总生存期。方法：根据PRISMA指南和PubMed、Scopus、Embase、Web of Science和Cochrane Library截至2023年12月31日的Cochrane协议，对包括11项研究的生存风险比（HR）进行系统评价和网络meta分析。评估手术、影像引导的热消融、立体定向全身放疗、化疗和最佳标准治疗（联合或单独）。采用化疗作为确定生存hr的治疗参考。然后对仅肺转移或多部位转移的结直肠癌患者进行网络回归。结果：在肺转移患者中，手术、立体定向体放疗和化疗联合治疗效果最好（HR 0.22），而单独使用影像引导热消融（HR 0.53）和手术（HR 0.57）治疗效果最好，但两者差异无统计学意义。在回归后，多模式治疗仍然是获得最佳生存收益的策略。然而，虽然手术（增量HR 0.26）在孤立性肺转移性疾病患者中发挥最重要的作用，但化疗（增量HR 0.3）在多转移性疾病患者中发挥主导作用。结论：多模式治疗对结直肠癌肺转移患者的总生存率有最大的提高。结合多种治疗策略可提高生存率，少转移患者从手术和局部治疗中获益更多，而多转移患者主要从化疗中获益，尽管在可行的情况下，消融和手术可以提高预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.