Systemic chemotherapy for patiënten met resectable or resected colorectal cancer liver metastases: An individual pati...

INTRODUCTION: The role of systemic chemotherapy for patients with resectable or resected colorectal cancer liver metastases (CRCLM) is debated. MATERIAL AND METHODS: After a systematic search in PubMed and EMBASE databases, we conducted a meta-analysis of individual patient data from randomised phase III trials comparing surgery plus systemic chemotherapy with surgery alone in patients with CRCLM. Analyses were performed in the overall intention-to-treat (ITT) population, in patients who had curative-intent surgery (resected population), and in those who received post-operative chemotherapy only. The primary endpoint was progression-free survival (PFS). RESULTS: 821 patients (411 surgery alone, 410 surgery plus systemic chemotherapy) from four trials (EORTC 40983/EPOC, FFCD-ACHBTH-AURC 9002, ENG, and UMIN C000000013) were included. Systemic chemotherapy improved PFS in the overall ITT (HR 0.79; 95 %CI: 0.67-0.93, p = 0.004), in the resected (HR 0.77; 95 %CI: 0.65-0.91, p = 0.003) and in the post-operative chemotherapy only (HR 0.76; 95 %CI: 0.61-0.95, p = 0.016) populations. Systemic chemotherapy also improved overall survival (OS) in the overall ITT (HR 0.82; 95 %CI: 0.68-1.0, p = 0.048) and in the resected (HR 0.81; 95 %CI: 0.66-1.00, p = 0.046) populations. After adjusting for prognostic factors in multivariable analyses, the effect of systemic chemotherapy remained significant for PFS in the overall ITT (p < 0.001) and in the post-operative chemotherapy only (p = 0.003) populations. An interaction between systemic chemotherapy and time to diagnosis of liver metastases for PFS was found in the overall ITT (p = 0.027) and in the resected (p = 0.024) populations. CONCLUSIONS: Systemic chemotherapy improves PFS of patients with resectable or resected CRCLM. This effect is stronger for patients with synchronous metastases.