{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:39:23Z","timestamp":1791225563165,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The lungs represent the second most common site of colorectal cancer metastases. Although surgery is commonly considered the best treatment, many other invasive and noninvasive procedures and treatments have been adopted to improve patient survival and there is no clear evidence in the literature of which is the more effective. The aim of this work was to identify which treatment confers the best gain in overall survival for patients with pulmonary metastases from colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A systematic review and network meta\u2010analysis of survival hazard ratio (HR) including 11 studies was conducted following the PRISMA guidelines and the Cochrane protocol on PubMed, Scopus, Embase, Web of Science and Cochrane Library up to 31 December 2023. Surgery, image\u2010guided thermoablation, stereotactic body radiotherapy, chemotherapy and best standard care, associated or alone, were evaluated. Chemotherapy was adopted as the treatment reference to define survival HRs. Network metaregression was then performed considering patients with pulmonary only or multisite metastases from colorectal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In patients with pulmonary metastases, the association of surgery, stereotactic body radiotherapy and chemotherapy is the best performing (HR 0.22), while the most effective components alone are image\u2010guided thermoablation (HR 0.53) and surgery (HR 0.57), although this was not significant. After metaregression, multimodal treatments still represent the strategy conferring the best survival gain. However, while surgery (incremental HR 0.26) has the most important role in patients with isolated pulmonary metastatic disease, chemotherapy (incremental HR 0.3) leads for patients with multimetastatic disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Multimodal treatment confers the best gain in overall survival in patients with pulmonary metastases from colorectal cancer. Combining multiple therapeutic strategies improves survival, with oligometastatic patients benefiting more from surgery and local therapies while multimetastatic patients mainly benefit from chemotherapy, although ablation and surgery can enhance outcomes when feasible.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.70002","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T02:56:16Z","timestamp":1737600976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Multimodal treatment improves survival in patients with lung metastases from colorectal cancer: A network meta\u2010analysis"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1475-4500","authenticated-orcid":false,"given":"Andrea","family":"Chierici","sequence":"first","affiliation":[{"name":"Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital Centre Hospitalier Universitaire de Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8215-5756","authenticated-orcid":false,"given":"Danilo","family":"Vinci","sequence":"additional","affiliation":[{"name":"Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital Centre Hospitalier Universitaire de Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Liddo","sequence":"additional","affiliation":[{"name":"Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital Centre Hospitalier Universitaire de Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Granieri","sequence":"additional","affiliation":[{"name":"General Surgery Department Ospedale di Vimercate, ASST Della Brianza  Vimercate Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Loi","sequence":"additional","affiliation":[{"name":"Radiotherapy Department Azienda Universitaria Ospedaliera Careggi Universit\u00e0 Degli Studi di Firenze  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Alifano","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Cochin Hospital, APHP Centre, University of Paris  Paris France"},{"name":"Inserm, U1138, Team \u00abCancer, Immune Control, and Escape\u00bb, Cordeliers Research Center University of Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Iannelli","sequence":"additional","affiliation":[{"name":"Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital Centre Hospitalier Universitaire de Nice  Nice France"},{"name":"Universit\u00e9 C\u00f4te d'Azur  Nice France"},{"name":"Team 8 \u201cHepatic Complications of Obesity and Alcohol\u201d Inserm, U1065  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"1","article-title":"GLOBOCAN\u2014colorectal cancer incidence in the world","volume":"419","author":"WHO (World Health Organization)","year":"2020","journal-title":"Glob Cancer Obs"},{"issue":"4","key":"e_1_2_11_3_1","first-page":"1","article-title":"Colon cancer screening methods: 2023 update","volume":"15","author":"Jayasinghe M","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2018.0021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.16383"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.105906"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.15.14401"},{"key":"e_1_2_11_9_1","first-page":"4","article-title":"ROBINS\u2010I: a tool for assessing risk of bias in non\u2010randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","journal-title":"BMJ"},{"issue":"1","key":"e_1_2_11_10_1","first-page":"1","article-title":"CINeMA: software for semiautomated assessment of the confidence in the results of network meta\u2010analysis","volume":"16","author":"Papakonstantinou T","year":"2020","journal-title":"Campbell Syst Rev"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-021-02166-3"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01308-8"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.201800167"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1044"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.9145"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010015\u20100060\u20108"},{"key":"e_1_2_11_18_1","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2021"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"e_1_2_11_20_1","unstructured":"R\u00fcckerG KrahnU KonigJ EfthimiouO DaviesA PapakonstantinouT et\u00a0al.netmeta: network meta\u2010analysis using frequentist methods. R package version 2.0\u20101;2021Available from:https:\/\/CRAN.R\u2010project.org\/package=netmeta"},{"key":"e_1_2_11_21_1","unstructured":"PetropoulouM SchwarzerG PanosA MavridisD.NMAoutlier: detecting outliers in network meta\u2010analysis. R package version 0.1.18;2021Available from:https:\/\/CRAN.R\u2010project.org\/package=NMAoutlier"},{"key":"e_1_2_11_22_1","unstructured":"HarrerM CuijpersP FurukawaT EbertDD.Companion R package for the guide \u201cdoing meta\u2010analysis in R\u201d;2019Available from:http:\/\/dmetar.protectlab.org\/"},{"key":"e_1_2_11_23_1","first-page":"132","article-title":"Treatment and survival of patients with metachronous colorectal lung metastases","volume":"24","author":"Hansdotter P","year":"2022","journal-title":"Colorectal Dis"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2016.02.001"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15113"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0142"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.05.024"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9783"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24952"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27108"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005466"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3646-1"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2020.09.006"},{"key":"e_1_2_11_34_1","unstructured":"NCCN Guidelines\u00ae for Colon Cancer\u2014version 2.2023.2023Available from:https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/colon.pdf"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2019.05.035"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw235"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2019.12.024"},{"issue":"11","key":"e_1_2_11_38_1","first-page":"e489","article-title":"Pulmonary metastasectomy in colorectal cancer: the PulMiCC randomised controlled trial","volume":"107","author":"Treasure T","year":"2020","journal-title":"Br J Surg"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.11.025"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T08:16:24Z","timestamp":1753517784000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.70002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/codi.70002"],"URL":"https:\/\/doi.org\/10.1111\/codi.70002","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-08-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70002"}}