Effect of primary tumor resection on survival in patients with asymptomatic unresectable metastatic colorectal cancer: a systematic review and meta-analysis

ABSTRACT

Objective

It remains controversial whether primary tumor resection (PTR) improves survival in patients with asymptomatic, unresectable metastatic colorectal cancer (mCRC). Therefore, we conducted a meta-analysis to assess the latest evidence on clinical outcomes.

Materials and Methods

We systematically searched PubMed, Web of Science, Cochrane Library, and Embase databases for eligible studies published between database inception and May 2022. RevMan 5.4 and Stata 16.0 were used for the meta-analysis.

Results

A total of nine studies were included, including four randomized controlled trials (RCTs) and five retrospective cohort studies. Meta-analysis showed that overall survival (OS) [HR = 0.89, 95%CI (0.74, 1.06), P = 0.19] and progression-free survival (PFS) [HR = 0.87, 95%CI (0.71, 1.06), P = 0.17] were not significantly different between the PTR and non-PTR groups. In the subgroup analysis, all subgroups showed no significant difference in OS between the two groups.

Conclusion

PTR may not provide additional survival benefits over chemotherapy in asymptomatic, unresectable mCRC patients. However, in view of the limitations of this study, more well-designed RCTs are needed to validate our conclusions.

KEYWORDS:

• Metastatic colorectal cancer
• chemotherapy
• primary tumor resection
• meta-analysis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Xiongfei Yang and Binbin Du were involved in the conception and design. Chengren Zhang, Cong Cao, Lili Liu, Yaochun Lv, Jingjing Li, Jiyong Lu and Shuai Wang contributed to the analysis and interpretation of the data. Chengren Zhang and Cong Cao participated in the drafting or revision of the paper. Xiongfei Yang and Yaochun Lv were involved in the final approval of the version to be published. All authors agree to take responsibility for all aspects of this work.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737140.2023.2149497

Additional information

Funding

This research was supported by the Scientific Research Fund of Gansu Provincial Hospital (20GSSY3-1, 21GSSYC-20) and the Science and Technology Fund of Lanzhou City (2022-ZD-47).