腹腔热灌注化疗联合全身化疗治疗胃癌腹膜转移的meta分析  

Hyperthermic intraperitoneal chemotherapy combined with systemic chemotherapy for gastric cancer peritoneal carcinomatosis:A meta-analysis

作　　者：陆一丹 郑松[2,3,4] 柏玉蓉[2,5] 孙杨承 Lu Yidan;Zheng Song;Bai Yurong;Sun Yangcheng(The Fourth Clinical Medical College,Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,China;Department of Medical Oncology,Hangzhou Cancer Hospital,Hangzhou 310006,China;Department of MedicalOncology,Affiliated Hangzhou First Hospital,Zhejiang University of Traditional Chinese Medicine,Hangzhou 310006,China;Department of Medical Oncology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School ofMedicine,Hangzhou 310006,China;Department of Medical Oncology,Affiliated Hangzhou First People’s Hospital,Nanjing Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学第四临床医学院,浙江杭州310053 [2]杭州市肿瘤医院肿瘤内科,浙江杭州310006 [3]浙江中医药大学附属杭州市第一人民医院肿瘤内科,浙江杭州310006 [4]浙江大学医学院附属杭州市第一人民医院肿瘤内科,浙江杭州310006 [5]南京医科大学附属杭州医院肿瘤内科,浙江杭州310006

出　　处：《实用肿瘤杂志》2020年第2期159-165,共7页Journal of Practical Oncology

基　　金：国家自然科学基金面上项目(81372660);浙江省科技计划公益技术应用研究计划项目(2017C33200);浙江省医药卫生科技计划(2013KYA157);浙江省中医药科技计划(2013ZA104)。

摘　　要：目的评价腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)联合全身化疗对比单纯全身化疗在胃癌腹膜转移(gastric cancer peritoneal carcinomatosis,GCPC)患者中的有效性及安全性。方法在MEDLINE、Cochrane Library和EMbase外文数据库中检索近10年有关HIPEC治疗GCPC的临床对照研究,筛选出HIPEC联合化疗对比单纯化疗的研究,分析1年总生存率(1-year overall survival rate,1y-OS)、中位无进展生存时间(median progression-free survival,mPFS)、中位总生存时间(median survival time,mOS)和安全性。计量资料采用风险比(hazard ratio,HR),计数资料采用相对危险度(risk ratio,RR)。结果共纳入随机对照研究(randomized controlled trials,RCTs)1项,高质量非随机对照研究(non-randomized controlled trials,NRCTs)4项,共157例患者(HIPEC组79例,对照组78例),均采用随机效应模型,HIPEC组1y-OS为68.4%,较对照组的26.9%提高[RR=0.51(95%CI:0.33~0.78),P=0.002];mOS范围在11.3~21个月,较对照组的4.3~11.1个月延长[HR=0.78(95%CI:0.68~0.88),P<0.01];m PFS较对照组差异无统计学意义[HR=0.64(95%CI:0.36~1.51),P=0.14];涉及安全性的研究1项,不良反应发生率组间比较差异无统计学意义(P>0.05)。结论HIPEC联合全身化疗对比单纯全身化疗能够延长GCPC患者生存,改善预后,安全性可。Objective To evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy(HIPEC)combined with systemic chemotherapy treatment for gastric cancer peritoneal carcinomatosis(GCPC).Methods The relevant clinical controlled studies were retrieved from the databases of MEDLINE,Cochrane Library and EMbase.The 1-year overall survival rate(1 y-OS),median progression-free survival(mPFS),median overall survival time(mOS)and safety were analyzed.Hazard ratios(HRs)were calculated for survival and risk ratios(RRs)were calculated for discrete variables.Results One randomized controlled trial(RCT)and 4 high-quality non-randomized controlled trials(NRCTs)were included,enrolling 157 patients(79 in the HIPEC group and 78 in the control group).Compared with the control group,the HIPEC group turned out to be of significantly higher improvement in the 1 y-OS(68.4%vs 26.9%;RR=0.51;95%CI:0.33~0.78;P=0.002)and mOS(11.3~21 months vs 4.3~11.1 months;HR=0.78;95%CI:0.68~0.88;P<0.01).There was no significant difference in mPFS(HR=0.64;95%CI:0.36~1.51;P=0.14).As for safety,there were no significant differences in adverse events between the two groups(P>0.05).Conclusions Compared to chemotherapy alone,HIPEC combined with systemic chemotherapy can prolong the survival of patients with GCPC,and the incidences of adverse events were not increased.

关 键 词：胃肿瘤 腹腔热灌注化疗 全身化疗 腹膜转移 META分析 

分 类 号：R735.2[医药卫生—肿瘤]