术前化疗对CRS+HIPEC治疗腹膜假黏液瘤预后影响的meta分析  

Impact of preoperative chemotherapy on prognosis of pseudomyxoma peritonei treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy:a meta-analysis

作　　者：张颖 赵鑫 陈佳梅 李雁 Zhang Ying;Zhao Xin;Chen Jiamei;Li Yan(Department of Oncology,Daxing Teaching Hospital,Capital Medical University,Beijing 102600,China;Department of Peritoneal Cancer Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Colorectal Surgery,Beijing Anorectal Hospital,Beijing 100120,China;Center of Oncology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Surgical Oncology,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]首都医科大学大兴教学医院肿瘤科,北京102600 [2]首都医科大学附属北京世纪坛医院腹膜肿瘤外科,北京100038 [3]北京市肛肠医院结直肠外科,北京100120 [4]武汉大学人民医院肿瘤中心,武汉430060 [5]清华大学附属北京清华长庚医院,北京102218

出　　处：《中华临床医师杂志(电子版)》2024年第9期826-835,共10页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京市医院管理局“登峰”人才培养计划(DFL20180701);北京市优秀人才培养资助集体项目(2017400003235J007)

摘　　要：目的探讨术前化疗对肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)治疗腹膜假黏液瘤(PMP)患者预后的影响。方法检索PubMed、Embase、Cochrane图书馆、中国学术期刊全文数据库(CNKI)、万方数据库,筛选关于术前化疗对CRS+HIPEC治疗PMP患者预后影响的队列研究。根据纳入及排除标准筛选文献,进行质量评价和数据提取,使用RevMan5.4和Stata15.1软件进行统计分析,结局指标为总生存期(OS),无进展生存期(PFS)和无疾病生存期(DFS)。结果17篇文献被纳入meta分析,14篇文献报道了术前化疗对OS的影响,meta分析结果显示,术前化疗组总体OS较非化疗组短(HR=1.58,P<0.001)。分层分析显示,高级别和高级别伴印戒细胞的病理类型患者,术前化疗组OS短于非术前化疗组(HR=1.62,P<0.001)。高加索人种给予术前化疗,OS短于非化疗组(HR=1.65,P<0.001),而亚洲人种中差异无统计学意义。7篇文献报道了术前化疗对PFS的影响,结果显示,术前化疗组总体PFS时间较非化疗组短(HR=1.62,P<0.001),分层分析显示,高级别和高级别伴印戒细胞的病理类型患者,术前化疗组较非化疗组PFS有下降趋势,但差异无统计学意义(HR=1.24,P=0.31),亚洲人种及高加索人种术前化疗组PFS均下降(HR=1.53和1.71,P=0.003和0.0002)。敏感性分析及发表偏倚检验均提示结果稳定。结论对于CRS+HIPEC治疗的PMP患者,给与术前化疗无OS和PFS获益,但因纳入文献均为回顾性研究,对基线资料、病理类型、化疗方案等可能的重要影响因素并未做更详细的区分,故仍需更严谨的前瞻性研究进一步验证。Objective To investigate the impact of preoperative chemotherapy on the prognosis of pseudomyxoma peritonei(PMP)treated by cytoreductive surgery(CRS)plus hyperthermic intraperitoneal chemotherapy(HIPEC).Methods A literature search was conducted on cohort studies on the effects of preoperative chemotherapy on the prognosis of PMP from PubMed,Embase,Cochrane Library,CNKI,and Wanfang Database.The literature was screened according to the inclusion and exclusion criteria,and quality evaluation and data extraction were carried out.RevMan5.4 and Stata15.1 software were used for statistical analyses.The outcome indicators were overall survival(OS),progression-free survival,and disease-free survival(DFS).Results Seventeen articles were included in the meta-analysis.Fourteen articles reported the impact of preoperative chemotherapy on OS.The results of meta-analysis showed that the OS of the preoperative chemotherapy group was shorter than that of the non-preoperative chemotherapy group(hazard ratio[HR]=1.58,P<0.00001).Stratified analysis showed that in patients with pathological types of high-grade tumors and high-grade tumors with signet ring cells,the OS of the preoperative chemotherapy group was shorter than that of the non-preoperative chemotherapy group(HR=1.62,P<0.00001).The OS of the preoperative chemotherapy group in Caucasian race was shorter than the non-chemotherapy group in Caucasian race(HR=1.65,P<0.001),but there was no statistically significant difference in the Asian race.Seven articles reported the impact of preoperative chemotherapy on PFS.The results showed that the PFS of the preoperative chemotherapy group was shorter than that of the non-chemotherapeutic group(HR=1.62,P<0.001).Stratified analysis showed that in patients with pathological types of high-grade tumors and highgrade tumors with signet ring cells,the PFS of the preoperative chemotherapy group was lower than that of the non-chemotherapeutic group,but the difference was not statistically significant(HR=1.24,P=0.31).In both Asian and Caucasia

关 键 词：肿瘤细胞减灭术 腹腔热灌注化疗 腹膜假黏液瘤 术前化疗 

分 类 号：R735.5[医药卫生—肿瘤]