A systematic review and network meta-analysis of RCTs: The effect of systemic immunotherapies on treatment outcomes and quality of life in patients with metastatic colorectal cancer.
{"title":"A systematic review and network meta-analysis of RCTs: The effect of systemic immunotherapies on treatment outcomes and quality of life in patients with metastatic colorectal cancer.","authors":"Yiying Zhu, Xiangwei Fu, Yonggang Dai","doi":"10.17219/acem/194037","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The impact of different systemic treatments on the health-related quality of life (HRQoL) in patients with metastatic colorectal cancer (mCRC) is still unclear.</p><p><strong>Objectives: </strong>To compare and evaluate the effects of various systemic interventions on the HRQoL in patients with mCRC.</p><p><strong>Material and methods: </strong>A thorough search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to locate relevant literature published in peer-reviewed journals. The risk ratio (RR) and 95% confidence intervals (95% CIs) were calculated. The heterogeneity was examined using p-value, Cochrane Q and I² statistics. The analysis was performed with RevMan 5.4. At least 2 treatment regimens were tested in phase II or III trials. The primary objectives were shortand long-term mean changes in EORTC QLQ-C30 GHS/QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30, Global Health Status/Quality of Life) and EQ-5D health utility scores (EuroQol 5 Dimension). Multivariate meta-regression was used to combine direct and indirect comparison data into a network meta-analysis with a random-effects consistency model. The surface under the cumulative ranking (SUCRA) probability curve was used to compare different systemic therapy combinations.</p><p><strong>Results: </strong>This meta-analysis involved 15 relevant randomized clinical trials (RCTs) with 7,699 patients with mCRC. The study had a low risk of bias (RoB) (p > 0.05 for Egger's regression test) and moderate heterogeneity (I2 < 60%). Results indicated that systemic therapies were substantially more effective than other agents in improving the overall survival (OS) of patients (RR: 0.85 (95% CI: 0.79-0.90); p < 0.001, I2 < 60%], ensuring progression-free survival (PFS) (RR 0.80 (95% CI: 0.75-0.85); p < 0.001; I2 < 60%), suggesting that there was moderate heterogeneity. Long-term findings demonstrated that cetuximab was the most effective treatment and was linked to a significant improvement in GHS/QoL.(coefficient [95% CI] = 0.23 [-0.68 to 0.96], p = 0.747). In terms of the longand short-term results of change in QLQ-C30 GHS/HUS QoL score, cetuximab performed the best (SUCRA 95.12%) among all therapies. It also showed a substantial advantage in comparison to chemotherapy (mean deviation (MD) 0.06, 95% CI: 0.01 to 0.09).</p><p><strong>Conclusion: </strong>This network meta-analysis found that cetuximab monotherapy improves HRQoL and prolongs OS and PFS in patients with mCRC.</p>","PeriodicalId":7306,"journal":{"name":"Advances in Clinical and Experimental Medicine","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Clinical and Experimental Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.17219/acem/194037","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The impact of different systemic treatments on the health-related quality of life (HRQoL) in patients with metastatic colorectal cancer (mCRC) is still unclear.
Objectives: To compare and evaluate the effects of various systemic interventions on the HRQoL in patients with mCRC.
Material and methods: A thorough search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to locate relevant literature published in peer-reviewed journals. The risk ratio (RR) and 95% confidence intervals (95% CIs) were calculated. The heterogeneity was examined using p-value, Cochrane Q and I² statistics. The analysis was performed with RevMan 5.4. At least 2 treatment regimens were tested in phase II or III trials. The primary objectives were shortand long-term mean changes in EORTC QLQ-C30 GHS/QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30, Global Health Status/Quality of Life) and EQ-5D health utility scores (EuroQol 5 Dimension). Multivariate meta-regression was used to combine direct and indirect comparison data into a network meta-analysis with a random-effects consistency model. The surface under the cumulative ranking (SUCRA) probability curve was used to compare different systemic therapy combinations.
Results: This meta-analysis involved 15 relevant randomized clinical trials (RCTs) with 7,699 patients with mCRC. The study had a low risk of bias (RoB) (p > 0.05 for Egger's regression test) and moderate heterogeneity (I2 < 60%). Results indicated that systemic therapies were substantially more effective than other agents in improving the overall survival (OS) of patients (RR: 0.85 (95% CI: 0.79-0.90); p < 0.001, I2 < 60%], ensuring progression-free survival (PFS) (RR 0.80 (95% CI: 0.75-0.85); p < 0.001; I2 < 60%), suggesting that there was moderate heterogeneity. Long-term findings demonstrated that cetuximab was the most effective treatment and was linked to a significant improvement in GHS/QoL.(coefficient [95% CI] = 0.23 [-0.68 to 0.96], p = 0.747). In terms of the longand short-term results of change in QLQ-C30 GHS/HUS QoL score, cetuximab performed the best (SUCRA 95.12%) among all therapies. It also showed a substantial advantage in comparison to chemotherapy (mean deviation (MD) 0.06, 95% CI: 0.01 to 0.09).
Conclusion: This network meta-analysis found that cetuximab monotherapy improves HRQoL and prolongs OS and PFS in patients with mCRC.
期刊介绍：
Advances in Clinical and Experimental Medicine has been published by the Wroclaw Medical University since 1992. Establishing the medical journal was the idea of Prof. Bogumił Halawa, Chair of the Department of Cardiology, and was fully supported by the Rector of Wroclaw Medical University, Prof. Zbigniew Knapik. Prof. Halawa was also the first editor-in-chief, between 1992-1997. The journal, then entitled "Postępy Medycyny Klinicznej i Doświadczalnej", appeared quarterly.
Prof. Leszek Paradowski was editor-in-chief from 1997-1999. In 1998 he initiated alterations in the profile and cover design of the journal which were accepted by the Editorial Board. The title was changed to Advances in Clinical and Experimental Medicine. Articles in English were welcomed. A number of outstanding representatives of medical science from Poland and abroad were invited to participate in the newly established International Editorial Staff.
Prof. Antonina Harłozińska-Szmyrka was editor-in-chief in years 2000-2005, in years 2006-2007 once again prof. Leszek Paradowski and prof. Maria Podolak-Dawidziak was editor-in-chief in years 2008-2016. Since 2017 the editor-in chief is prof. Maciej Bagłaj.
Since July 2005, original papers have been published only in English. Case reports are no longer accepted. The manuscripts are reviewed by two independent reviewers and a statistical reviewer, and English texts are proofread by a native speaker.
The journal has been indexed in several databases: Scopus, Ulrich’sTM International Periodicals Directory, Index Copernicus and since 2007 in Thomson Reuters databases: Science Citation Index Expanded i Journal Citation Reports/Science Edition.
In 2010 the journal obtained Impact Factor which is now 1.179 pts. Articles published in the journal are worth 15 points among Polish journals according to the Polish Committee for Scientific Research and 169.43 points according to the Index Copernicus.
Since November 7, 2012, Advances in Clinical and Experimental Medicine has been indexed and included in National Library of Medicine’s MEDLINE database. English abstracts printed in the journal are included and searchable using PubMed http://www.ncbi.nlm.nih.gov/pubmed.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
