腹腔热灌注联合全身化疗治疗胃癌恶性腹水的疗效与安全性Meta分析  

Efficacy and safety of hyperthermic intraperitoneal chemotherapy combined with systemic chemotherapy in treatment of gastric cancer with malignant ascites:A Meta-analysis

作　　者：袁泽伟 孙敏[2] 向真贤 黄思澔 姜军 熊斌[1] Yuan Zewei;Sun Min;Xiang Zhenxian;Huang Sihao;Jiang;Xlong Bin(Department of Gastrointestinal Surgery ＆ Department of Gastric Colorectal Surgical Oneology,Zhongnan Hospital of Wuhan University,Hubei Key Laboratory of Tumor Biological Behaviors,Hubei Wuhan 430071,China;Department of General Surgery,Taihe Hospital,Hubei University of Medicbw,Hebei Shiyan 442008,China.)

机构地区：[1]武汉大学中南医院胃肠外科&胃结直肠肿瘤外科,肿瘤生物学行为湖北省重点实验室,湖北武汉430071 [2]湖北医药学院附属太和医院普外科,湖北十堰442008

出　　处：《现代肿瘤医学》2018年第13期2094-2099,共6页Journal of Modern Oncology

摘　　要：目的:评估腹腔热灌注(hyperthermic intraperitoneal chemotherapy,HIPEC)联合全身化疗(systemic chemotherapy,SC)治疗胃癌恶性腹水疗效与安全性。方法:检索Cochrane Library、Embase、Pub Med、Web of Science、中国知网、万方数据库、维普数据库、中国生物医学文献数据库至2017年9月。按照纳入标准筛选文献,评价文献质量并提取数据;以比值比(odds ratio,OR)、危险比(hazard ratio,HR)及各自95%可信区间(confidence interval,CI)作为统计效应量;采用Revman 5.3进行Meta分析。结果:最终纳入9个研究,共693例胃癌恶性腹水患者。Meta分析结果显示:近期疗效方面,与单纯全身化疗相比,腹腔热灌注联合全身化疗可显著提高完全缓解(28.75%vs 8.01%,OR=4.32,95%CI:2.72~6.87,P<0.001)、有效率(75.41%vs 45.15%,OR=3.76,95%CI:2.55~5.54,P<0.001)和疾病控制率(94.57%vs 79.88%,OR=4.38,95%CI:2.57~7.44,P<0.001),且差异均有统计学意义;远期疗效方面,腹腔热灌注联合全身化疗可提高患者的总生存期(HR=0.78,95%CI:0.68~0.88,P<0.001)和无进展生存期(HR=0.72,95%CI:0.52~0.99,P=0.04),差异也均有统计学意义;而在安全性方面,两组毒副反应发生率无明显差别(均P>0.05)。结论:腹腔热灌注联合全身化疗治疗胃癌恶性腹水的有效性优于单纯全身化疗,不增加毒副反应风险;但仍需开展更高质量、大样本、多中心临床试验进一步验证。Objective：To evaluate the efficacy and safety of hyperthermie intraperitoneal chemotherapy （ HIPEC ） combined with systemic chemotherapy （SC） in treatment of gastric cancer with malignant aseites. Methods：The rele vant studies were retrieved from the databases of Coehrane Library, Embase, PubMed, Web of Science, CNKI, Wan fang,VIP,CBM from the establishment time to September 2017. We selected literatures in accordance with the inclu sion criteria. And valid data was extracted after accessing the quality- of these studies. Odds ratio （OR） and hazard ra tio （HR）, as well as their respective 95 % confidence interval （CI） were used as statistical indicators. Rewnan 5.3 software was used for this Meta - analysis. Results ： Finally,9 studies were included, enrolling 693 patients with gastric cancer with malignant aseites. Compared with SC group, HIPEC plus SC group turned out to be of higher improvenlent in both short - term and long - term efficacy, such as complete response （28.75% vs 8.01% , OR = 4.32,95% C1：2.72 - 6.87,P 〈 0.001 ） , response rate （ 75.41% vs 45.15 % , OR = 3.76,95 % CI ： 2.55 - 5.54, P 〈 0. 001 ） , disease control rate （94.57% vs 79.88%,OR =4.38,95% CI：2. 57 ~7.44,P 〈0. 001） ,overall survival （ HR = 0.78,95 % C1：0.68 ~ 0.88, P 〈 0. 001 ） , progression - free survival （ HR = 0.72,95 % C1：0.52 ~ 0.99, P = 0.04）. As for safety-, there were no significant differences in adverse events between two groups （ all P 〉 0.05 ）. Con- clusion ：The efficacy of HIPEC plus SC in the treatment of gastric cancer with malignant aseites was better than that of systemic chemotherapy alone. And the incidences of adverse events were not increased. However,it needs to be further verified by performing higher quality-, larger sample and multieenter clinical trials.

关 键 词：胃癌 恶性腹水 腹腔热灌注化疗 META分析 

分 类 号：R735.2[医药卫生—肿瘤]