预防性腹腔热灌注化疗治疗进展期胃癌临床疗效的meta分析  

Clinical efficacy of prophylactic hyperthermic intraperitoneal chemotherapy for advanced gastric cancer:a meta-analysis

作　　者：柏玉蓉 陆一丹 孙杨承 马胜林 郑松[1,2,3,4,6] Bai Yurong;Lu Yidan;Sun Yangcheng;Ma Shenglin;Zheng Song(Department of Oncology,Hangzhou First People's Hospital,Nanjing Medical University,Hangzhou 310000,China;Department of Oncology,Hangzhou First People's Hospital,Hangzhou 310000,China;Department of Oncology,the Fourth Clinical Medical College,Zhejiang University of Traditional Chinese Medicine,Hangzhou 310000,China;Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province,Hangzhou 310000,China;Department of Radiation Oncology,Hangzhou Cancer Hospital,Hangzhou 310000,China;Department of Oncology,Hangzhou Cancer Hospital,Hangzhou 310000,China)

机构地区：[1]南京医科大学附属杭州医院肿瘤内科,浙江杭州310000 [2]杭州市第一人民医院肿瘤内科,浙江杭州310000 [3]浙江中医药大学第四临床医学院肿瘤内科,浙江杭州310000 [4]浙江省临床肿瘤药理与毒理学研究重点实验室,浙江杭州310000 [5]杭州市肿瘤医院肿瘤放疗科,浙江杭州310000 [6]杭州市肿瘤医院肿瘤内科,浙江杭州310000

出　　处：《实用肿瘤杂志》2021年第4期306-313,共8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：目的探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)预防性治疗进展期胃癌的疗效和安性性。方法检索1999年1月至2020年10月PubMed、EMBASE、Cochrane Library、CNKI、万方和维普数据库发表的比较胃癌根治术后预防性HIPEC与单纯手术治疗的随机对照试验和非随机对照试验。以胃癌根治术后行HIPEC的患者为HIPEC组,术后未行HIPEC的患者为对照组。采用Stata15.1软件进行统计学分析,比较两组患者的各类资料。主要研究终点为3年无瘤生存(disease free survival,DFS)率、5年总生存(overall survival,OS)率以及腹膜转移率;次要研究终点为2年DFS率、3年OS率以及安全性分析。结果纳入14项研究共1506例患者,其中HIPEC组582例,对照组924例。综合分析显示,HIPEC组3年DFS率高于对照组(OR=2.66,95%CI:1.88~3.77,P<0.01),5年OS率高于对照组(OR=1.76,95%CI:1.02~3.54,P=0.043),腹膜转移率低于对照组(OR=0.21,95%CI:0.11~0.41,P<0.01)。HIPEC组2年DFS率(OR=2.41,95%CI:1.47~3.95,P=0.001)和3年OS率(OR=2.33,95%CI:1.58~3.43,P<0.01)均高于对照组。两组间不良事件发生率比较,差异无统计学意义(OR=1.031,95%CI:0.666~1.595,P=0.891)。结论预防性HIPEC可以提高进展期胃癌患者DFS和OS,降低胃癌术后腹膜转移率,并不增加并发症发生率,临床应用安全有效。Objective To investigate the efficacy and safety of hyperthermic intraperitoneal chemotherapy(HIPEC)in the treatment of advanced gastric cancer.Methods Literatures of randomized controlled trials(RCTs)and non-randomized controlled trials(NRCTs)published in PubMed,EMBASE,Cochrane Library,CNKI,Wanfang and VIP databases comparing treatment methods for advanced gastric cancer between January 1999 and October 2020 were retrieved.Patients who received HIPEC after radical gastrectomy were selected as the HIPEC group,and those who did not receive HIPEC were selected as the control group.Stata15.1 software was used for statistical analysis and the data were compared between the two groups.The primary outcomes were 3-year disease-free survival(DFS)rates,5-year overall survival(OS)rates and peritoneal recurrence rates.Secondary outcomes were 2-year DFS rates,3-year OS rates and overall complications.Results A total of 1506 patients from 4 RCTs and 10 NRCTs were included,of whom,582 were in the HIPEC group and 924 in the control group.Pooled analysis showed that the 3-year DFS rate(OR=2.66,95%CI:1.88~3.77,P<0.01)and 5-year OS rate(OR=1.76,95%CI:1.02~3.54,P=0.043)was higher in the HIPEC group than in the control group,and peritoneal recurrence rate of the HIPEC group(OR=0.21,95%CI:0.11~0.41,P<0.01)was significantly lower than that of the control group.2-year DFS rate(OR=2.41,95%CI:1.47~3.95,P=0.001)and 3-year OS rate(OR=2.33,95%CI:1.58~3.43,P<0.01)was significantly higher in the HIPEC group than in the control group.There was no significant difference in the incidence of complications(OR=1.031,95%CI:0.666~1.595,P=0.891)between two groups.Conclusions Prophylactic HIPEC for advanced gastric cancer patients can achieve a survival advantage and decrease the incidence of peritoneal recurrence.It is safe and effective in clinical practice.

关 键 词：胃癌 高温 诱发 腹腔热灌注化疗 治疗结果 META分析 

分 类 号：R735.2[医药卫生—肿瘤]