Curative versus palliative treatments for colorectal cancer with peritoneal carcinomatosis: a systematic review and meta-analysis

// Wenqiong Wu 1 , Shipeng Yan 2 , Xianzhen Liao 2 , Haifang Xiao 2 , Zhongxi Fu 3 , Lizhang Chen 4 , Jinsong Mou 5 , Haibo Yu 6 , Lian Zhao 7, 8 and Xiangguo Liu 2 1 Department of Radiation Oncology, Hunan Cancer Hospital–The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China 2 Department of Cancer Prevention and Control, Hunan Cancer Hospital–The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China 3 Department of Chronic Diseases Prevention and Control, Centers for Disease Control and Prevention of Hunan, Changsha, Hunan Province, China 4 Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China 5 Department of Epidemiology and Health Statistics, Changsha Medical University, Changsha, Hunan Province, China 6 Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China 7 Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China 8 Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, Hunan Province, China Correspondence to: Shipeng Yan, email: shipengyan86@126.com Keywords: meta-analysis, cytoreductive surgery, intraperitoneal chemotherapy, colorectal cancer, peritoneal carcinomatosis Received: June 08, 2017      Accepted: October 05, 2017      Published: October 20, 2017 ABSTRACT The objective of this study was to provide an up-to-date summary of the current evidence that may be useful for updating guidelines. We comprehensively searched the published literatures and conferences for studies that compared curative with palliative treatments in colorectal cancer patients with peritoneal metastasis. The primary outcomes considered in this study were three- and five-year overall survival rates. We pooled data across studies and estimated summary effect sizes. Overall, patients who received curative treatments had improved three-year survival (hazard ratio (HR), 2.19 [95% CI, 1.83 to 2.62]) and five-year survival (HR, 2.22 [95% CI, 1.83 to 2.69]) compared with those who received palliative treatments. Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% CI, 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47]). Curative treatments improved overall survival in colorectal cancer patients with peritoneal metastasis and did not increase the risk of treatment-related mortality. Curative treatments were associated with a higher risk of treatment-related morbidity. These data highlight the importance for further investigation aimed at prevention of treatment-associated morbidity.