胃癌术中联合术后腹腔热灌注化疗的Meta分析  

Intraperitoneal hyperthermic perfusion chemotherapy for resectable advanced gastric cancer:a Meta-analysis

作　　者：李征[1,2] 米登海[1,2,3] 杨克虎[1,2] 曹农[2] 田金徽[1] 马彬[1] 

机构地区：[1]兰州大学循证医学中心,甘肃兰州730000 [2]兰州大学第一临床医学院,甘肃兰州730000 [3]甘肃省第二人民医院肿瘤科,甘肃兰州730000

出　　处：《实用肿瘤杂志》2012年第6期636-642,共7页Journal of Practical Oncology

基　　金：甘肃省卫生行业科研计划项目(GSWST09-06);兰州大学循证医学中心循证医学研究生创新基金(2010LDEBM-A)

摘　　要：目的系统评价进展期胃癌术中联合术后腹腔热灌注化疗(intraperitoneal hyperthermic perfusion chemotherapy,IHPC)的疗效及安全性,为临床实践与研究提供参考。方法计算机检索Cochrane Library、PubMed、EMBASE和中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库、数字化期刊全文数据库,同时辅以其他检索。收集所有比较进展期胃癌术中联合术后IHPC与术后常规静脉全身化疗(intravenous chemotherapy,IC)的随机对照试验(randomized controlled trial,RCT)。选择适合本研究特点的质量评价标准对纳入文献进行质量评价,使用RevMan 5.1软件进行Meta分析。结果共纳入13篇RCT(1 804例患者)。(1)疗效评价:IHPC组的1、2、3、5年生存率明显高于对照组,其Meta分析结果分别为[HR=1.65,95%CI=(1.19,2.30)]、[HR=1.76,95%CI=(1.25,2.49)]、[HR=2.40,95%CI=(1.99,2.90)]、[HR=2.55,95%CI=(2.04,3.17)],其差异均有统计学意义;IHPC组的1、3、5年复发率和3、5年远处转移率明显低于对照组,其OR和95%CI分别为[0.38,(0.18,0.77)]、[0.26,(0.18,0.37)]、[0.30,(0.23,0.39)]、[0.32,(0.15,0.68)]、[0.51,(0.32,0.81)],其差异均有统计学意义。(2)安全性评价:两组恶心呕吐、骨髓抑制及肝脏损害发生率的差异无统计学意义;而腹痛发生率的差异有统计学意义,IHPC组发生率高于对照组,其OR和95%CI为[4.23,(2.14,8.35)]。结论比较常规静脉化疗,进展期胃癌术中联合术后IHPC疗法可降低术后复发率和远处转移率,提高患者远期生存率并且安全性可以接受,但其安全性评价尚需大样本高质量的RCT进一步验证,以确定术中联合术后IHPC疗法临床推广的价值和可行性。Objective To evaluate the efficacy and safety of intraoperative combined with postoperative intraperitoneal hyperthermic perfusion chemotherapy（IHPC） for the treatment of advanced gastric cancer.Methods The databases of Cochrane Library,PubMed,EMBASE,CBM,CNKI,VIP,Wanfang and other sources were searched,and communication with other authors were also made.All relevant randomized controlled trials（RCTs） were collected to compare intraoperative plus postoperative IHPC with routine intravenous chemotherapy（IC）alone for advanced gastric cancer.The quality of the included studies was assessed by adequate standard.Meta-analysis was conducted by RevMan 5.1 software.Results Thirteen RCTs involving 1 804 patients were included.The efficacy evaluation by Meta-analysis revealed that the 1,2,3,5-year survival rates of IHPC group were higher than those of IC group.The Meta-results of survival rates were,,and,respectively.The 1,3,5-year recurrence rate and 3,5-year distant metastasis rate of IHPC group were lower than those of IC group.The OR value and 95% CI were [0.38,（0.18,0.77）],[0.26,（0.18,0.37）],[0.30,（0.23,0.39）],[0.32,（0.15,0.68）] and [0.51,（0.32,0.81）],respectively.The safety evaluation revealed by Meta-analysis showed that there was significant difference between IHPC group and IC group in the incidence of abdominal pain,the OR value and 95% CI was [4.23,（2.14,8.35）],while there was no significant difference between IHPC group and IC group in the incidence of nausea and vomiting,bone marrow inhibition and hepatic lesion.Conclusion Compared with routine IC,intraoperative plus postoperative IHPC can improve survival rate and reduce recurrence rate and distant metastasis rate,besides its side effects are acceptable.More large-sample and high quality RCTs are needed to verify its long-term effect.

关 键 词：胃肿瘤 药物疗法 高温 诱发 抗肿瘤联合化疗方案 治疗应用 手术后期间 输注 胃肠外 存活率 随机对照试验 META分析 

分 类 号：R735.2[医药卫生—肿瘤]