Introduction
Materials and Methods
Search Strategy
Selection Criteria
Outcomes of Interest
Statistical Analysis
Results
Eligible Studies
Survival
Treatment strategy | Mean survival months, [95% CI] |
---|---|
Intact primary tumor without chemotherapy | 4.02 [2.81, 5.23] |
Resected primary tumor without chemotherapy | 7.42 [3.96, 10.87] |
Intact primary tumor and chemotherapy | 14.30 [12.56, 16.05] |
Intact primary tumor and bevacizumab | 17.27 [15.61, 18.94] |
Resected primary tumor and chemotherapy | 21.52 [19.82, 23.22] |
Resected primary tumor and bevacizumab | 27.52 [21.89, 33.14] |
Outcome | No. of studies | No. of patients | HR/MD [95% CI] | P value |
---|---|---|---|---|
Overall survival [PTR] versus [PTI] | ||||
HR | 70 | 94,615 versus 66,557 | 0.59 [0.54, 0.64] | < 0.0001 |
MD | 65 | 93,422 versus 65,879 | 7.27 [6.33, 8.21] | < 0.0001 |
Cancer-specific survival [PTR] versus [PTI] | ||||
HR | 3 | 29,918 versus 16,819 | 0.47 [0.40, 0.57] | < 0.0001 |
MD | 1 | 1782 versus 200 | 10.80 [2.59, 19.01] | 0.01 |
Progression-free survival [PTR] versus [PTI] | ||||
HR | 6 | 2942 versus 1504 | 0.76 [0.71, 0.80] | < 0.0001 |
MD | 6 | 2718 versus 1305 | 1.67 [1.01, 2.33] | < 0.0001 |
Overall survival [PTR] versus [PTI], only stage IV (metastatic) | ||||
HR | 59 | 91,825 versus 65,200 | 0.60 [0.54, 0.66] | < 0.0001 |
MD | 52 | 90,484 versus 64,468 | 7.23 [6.15, 8.30] | < 0.0001 |
Overall survival [PTR] versus [PTI], patients diagnosed from 2000 onwards | ||||
HR | 37 | 54,662 versus 44,932 | 0.62 [0.56, 0.70] | < 0.0001 |
MD | 33 | 54,324 versus 44,730 | 7.29 [5.99, 8.60] | < 0.0001 |
Overall survival [PTR] versus [PTI], only asymptomatic patients | ||||
HR | 13 | 1254 versus 1033 | 0.69 [0.54, 0.88] | 0.002 |
MD | 10 | 595 versus 597 | 3.86 [1.45, 6.27] | 0.002 |
Overall survival [PTR] versus [PTI], studies with propensity score analysis | ||||
HR | 9 | 47,769 versus 38,803 | 0.65 [0.48, 0.86] | 0.003 |
MD | 5 | 2714 versus 2587 | 5.68 [2.63, 8.73] | 0.0003 |
Overall survival [PTR] versus [PTI], elderly patients ≥ 65 years old | ||||
HR | 2 | 6497 versus 2578 | 0.46 [0.34, 0.63] | < 0.0001 |
MD | 3 | 6616 versus 2662 | 7.71 [5.98, 9.43] | < 0.0001 |
Overall survival [PTR] versus [PTI], colon primary tumor | ||||
HR | 3 | 8938 versus 6848 | 0.58 [0.38, 0.89] | 0.01 |
MD | 5 | 11,397 versus 8973 | 6.31 [2.77, 9.84] | 0.0005 |
Overall survival [PTR] versus [PTI], rectal primary tumor | ||||
HR | 6 | 718 versus 536 | 0.54 [0.38, 0.78] | 0.0009 |
MD | 5 | 1070 versus 1503 | 6.88 [5.13, 8.64] | < 0.0001 |
Overall survival [PTR] versus [NRS] non-resectional surgery | ||||
HR | 9 | 1070 versus 684 | 0.56 [0.41, 0.75] | < 0.0001 |
MD | 11 | 870 versus 467 | 8.72 [7.21, 10.24] | < 0.0001 |
Overall survival [PTR] versus [PTI], no chemotherapy given | ||||
HR | 8 | 6630 versus 5439 | 0.63 [0.47, 0.84] | 0.002 |
MD | 4 | 304 versus 326 | 3.52 [− 0.59, 7.62] | 0.09 |
Overall survival [PTR] versus [PTI], all received chemotherapy | ||||
HR | 32 | 51,177 versus 39,230 | 0.59 [0.51, 0.67] | < 0.0001 |
MD | 27 | 47,643 versus 38,271 | 6.81 [5.59, 8.04] | < 0.0001 |
Overall survival [PTR] versus [PTI], all received bevacizumab | ||||
HR | 5 | 2095 versus 901 | 0.59 [0.41, 0.86] | 0.005 |
MD | 4 | 395 versus 194 | 10.56 [2.43, 18.69] | 0.01 |
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patients with metastatic (stage IV) disease (HR 0.60, P < 0.0001) by 7.23 months (MD 7.23, P < 0.0001)
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studies recruiting patients from 2000 onwards (HR 0.62, P < 0.0001; MD 7.29, P < 0.0001)
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asymptomatic patients (HR 0.69, P = 0.002; MD 3.86, P = 0.002)
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studies which performed propensity score-matched analysis (HR 0.65, P = 0.003; MD 5.68, P = 0.0003)
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elderly patients (aged 65 and older) (HR 0.46, P < 0.0001; MD 7.71, P < 0.0001)
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colon cancer (HR 0.58, P = 0.01; MD 6.31, P = 0.0005)
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rectal cancer (HR 0.54, P = 0.0009; MD 6.88, P < 0.0001)
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comparison of patients after PTR with patients after NRS (HR 0.56, P < 0.0001; MD 8.72, P < 0.0001)
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patients who did not receive chemotherapy (HR 0.63, P = 0.002), although no significant difference in the duration of survival was demonstrated (MD 3.52, P = 0.09)
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patients receiving chemotherapy (HR 0.59, P < 0.0001; MD 6.81, P < 0.0001)
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patients receiving bevacizumab (HR 0.59, P = 0.005; MD 10.56, P = 0.01)
Adverse Events
Adverse event | Proportion [95% CI] |
---|---|
Primary tumor intact (PTI) | |
Total adverse events | 21.7 [14.9–28.4] |
Adverse events requiring surgery | 15.8 [9.0–22.5] |
Obstruction | 14.4 [8.3–20.6] |
Anemia | 11.0 [1.9–20.1] |
Hemorrhage | 1.5 [0.5–2.6] |
Perforation | 0.6 [0.2–1.0] |
Fistula | 0.3 [0–0.8] |
Non-resectional surgery (NRS) | |
30-day mortality | 10.6 [6.5–14.7] |
Total adverse events | 21.7 [13.8–29.6] |
Major adverse events | 7.9 [2.4–13.4] |
Minor adverse events | 21.7 [16.2–27.2] |
Reoperation | 0.1 [0–2.4] |
Respiratory adverse events | 3.0 [0.6–5.3] |
Hemorrhage | 2.4 [0.3–4.5] |
Cardiac adverse events | 2.3 [0.2–4.4] |
Ileus/bowel obstruction | 1.9 [0.1–3.6] |
Urinary adverse events | 1.7 [0–3.5] |
DVT/PE | 1.0 [0–2.4] |
Adverse event | Proportion % [95% CI] |
---|---|
30-day mortality | 4.5 [3.1–5.9] |
Total adverse events | 22.4 [17.9–26.8] |
Major adverse events | 10.2 [7.4–13] |
Minor adverse events | 18.5 [14.1–22.9] |
Reoperation | 2.5 [1.5–3.5] |
Wound infection | 5.7 [3.9–7.4] |
Ileus/bowel obstruction | 4.0 [2.6–5.5] |
Urinary adverse events | 3.7 [2.1–5.3] |
Respiratory adverse events | 2.9 [1.7–4.0] |
Intraabdominal collection/sepsis | 2.2 [1.1–3.3] |
Cardiac adverse events | 1.9 [1.1–2.7] |
Anastomotic leak | 1.6 [1.0–2.2] |
Hemorrhage | 1.1 [0.6–1.7] |
Wound dehiscence | 0.7 [0.3–1.1] |
DVT/PE | 0.6 [0.2–0.1] |
Cerebrovascular accident | 0.3 [0–0.6] |