A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases

Julian F Daza; Natalie M Solis; Sameer Parpia; Steven Gallinger; Carol-Anne Moulton; Emilie P Belley-Cote; Mark N Levine; Pablo E Serrano

doi:10.1016/j.ejso.2019.03.025

A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases

Eur J Surg Oncol. 2019 Aug;45(8):1341-1348. doi: 10.1016/j.ejso.2019.03.025. Epub 2019 Mar 21.

Authors

Julian F Daza¹, Natalie M Solis², Sameer Parpia³, Steven Gallinger¹, Carol-Anne Moulton¹, Emilie P Belley-Cote³, Mark N Levine⁴, Pablo E Serrano⁵

Affiliations

¹ Department of Surgery, University of Toronto, Toronto, ON, Canada.
² Department of Surgery, McMaster University, Hamilton, ON, Canada.
³ Ontario Clinical Oncology Group, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Hamilton, ON, Canada.
⁴ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Department of Surgery, McMaster University, Hamilton, ON, Canada; Ontario Clinical Oncology Group, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: serrano@mcmaster.ca.

PMID: 30928334
DOI: 10.1016/j.ejso.2019.03.025

Abstract

Background: Positron emission tomography (PET), alone or combined with computed tomography (CT), potentially enhances detection of occult metastatic colorectal cancer.

Methods: We compared the impact of PET/PET-CT with conventional imaging, versus conventional imaging alone, in patients with potentially resectable colorectal cancer liver metastases. MEDLINE, EMBASE, and CENTRAL were searched for studies investigating PET/PET-CT to determine resectability. Outcomes included overall (OS), disease-free survival (DFS), change in surgical management, and futile laparotomy. Evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A pre-specified protocol was registered in PROSPERO.

Results: Of 4034 articles, two randomized trials (n = 554), and 11 non-randomized studies (n = 2251) were included. PET/PET-CT did not improve OS (hazard ratio [HR] 0.94, 95% CI 0.69-1.26, moderate quality) or DFS (HR 1.01, 95% CI 0.82-1.26, moderate quality). In the two trials, PET/PET-CT changed surgical management in 8% of cases (95% CI 5-11%, high quality), and did not significantly reduce futile laparotomies (risk ratio 0.59, 95% CI 0.24-1.47, low quality). Among non-randomized studies, PET/PET-CT changed surgical management in 20% of cases (95% CI 17-22%, very low quality) and reduced futile laparotomies (odds ratio 0.51, 95% CI 0.32-0.81, very low quality).

Conclusions: Moderate-quality evidence suggests that preoperative PET/PET-CT does not improve OS or DFS in patients with colorectal cancer liver metastases. These results do not support routine use of PET/PET-CT in patients with potentially resectable disease. The main limitation of this study was the lack of randomized studies.

Keywords: Colorectal cancer liver metastases; Computerized tomography (PET-CT); Disease-free survival; Overall survival; Positron emission tomography; Positron emission tomography (PET).

Publication types

Comparative Study
Meta-Analysis
Systematic Review

MeSH terms

Canada
Cause of Death
Colectomy / methods
Colectomy / mortality
Colorectal Neoplasms / mortality
Colorectal Neoplasms / pathology*
Colorectal Neoplasms / surgery
Controlled Clinical Trials as Topic
Disease-Free Survival
Female
Hepatectomy / methods*
Humans
Liver Neoplasms / diagnostic imaging*
Liver Neoplasms / mortality
Liver Neoplasms / secondary*
Liver Neoplasms / surgery
Male
Neoplasm Invasiveness / pathology
Neoplasm Staging
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography / methods*
Preoperative Care / methods
Prognosis
Randomized Controlled Trials as Topic
Risk Assessment
Role
Survival Analysis
Treatment Outcome