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2015 ; 94
(1
): e379
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Systematic review with network meta-analysis: adjuvant chemotherapy for resected
colorectal liver metastases
#MMPMID25569666
Zhu GQ
; You J
; Shi KQ
; He SY
; Wang LR
; Chen YP
; Braddock M
; Zheng MH
Medicine (Baltimore)
2015[Jan]; 94
(1
): e379
PMID25569666
show ga
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.