The 30-year experience-A meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer.
The 30-year experience-A meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer.
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对胃癌治疗中高温腹膜化疗的随机和高质量非随机研究的30年经验 - A荟萃分析。
DOI：
10.1016/j.ejca.2017.03.030
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Woo Y
中科院分区：
文献类型：
--
作者：
Desiderio J;Chao J;Melstrom L;Warner S;Tozzi F;Fong Y;Parisi A;Woo Y
高温腹腔化疗（HIPEC）已被用于预防和治疗胃癌腹膜癌病的各种多模式策略。目的：系统评价HIPEC在胃癌中的作用，明确其在腹膜疾病进展不同阶段的疗效。Medline和Embase数据库，从1985年1月1日到2016年6月1日。随机对照试验（RTC）和高质量的非随机对照试验（NRCTs）选择一个有效的工具（非随机研究方法学指数）比较HIPEC和标准肿瘤治疗晚期胃癌伴和不伴腹膜癌的治疗。随机效应网络元分析。主要结局是总生存和疾病复发率。次要结局是总并发症、并发症类型和复发部位。共纳入11项rct和21项NRCTs（2520例患者）。对于不存在腹膜癌（PC）的患者，HIPEC组与对照组在3年或5年的总生存率比较，HIPEC组优于对照组（RR=0.82， P=0.01）。PC患者的3年总生存率无差异（RR=0.99， P=0.85），但HIPEC组的中位生存期延长了4个月（WMD=4.04， P<0.001）。HIPEC与PC患者（RR=2.15， P<0.01）和非PC患者（RR=2.17， P<0.01）的并发症风险均显著升高相关。HIPEC组的风险增加与全身药物毒性有关。两组吻合口瘘发生率相近。我们的研究证明了HIPEC作为一种预防策略的生存优势，并表明疾病负担仅限于细胞学阳性和有限淋巴结累及的患者可能从HIPEC中获益最多。对于广泛性癌患者，细胞减少手术的完整性是生存的关键预后因素。未来的随机对照试验应该更好地定义患者选择标准。
Hyperthermic intraperitoneal chemotherapy (HIPEC) has been employed within various multimodality strategies for the prevention and treatment of gastric cancer peritoneal carcinomatosis. To systematically evaluate the role of HIPEC in gastric cancer and clarify its effectiveness at different stages of peritoneal disease progression. Medline and Embase databases between January 1, 1985, and June 1, 2016. Randomized control trials (RTC) and high-quality nonrandomized control trials (NRCTs) selected on a validated tool (Methodological Index for Nonrandomized Studies) comparing HIPEC and standard oncological management for the treatment of advanced stage gastric cancer with and without peritoneal carcinomatosis were considered. A random-effects network meta-analysis. The primary outcomes were overall survival and disease recurrence. Secondary outcomes were overall complications, type of complications, and sites of recurrence. A total of 11 RCTs and 21 NRCTs (2520 patients) were included. For patients without the presence of peritoneal carcinomatosis (PC), the overall survival rates between the HIPEC and control groups at 3 or 5 years resulted in favor of the HIPEC group (RR=0.82, P=0.01). No difference in the 3-year overall survival (RR=0.99, P=0.85) in but a prolonged median survival of 4 months in favor of the HIPEC group (WMD=4.04, P<0.001) was seen in patients with PC. HIPEC was associated with significantly higher risk of complications for both patients with PC (RR=2.15, P<0.01) and without (RR=2.17, P<0.01). This increased risk in the HIPEC group was related to systemic drugs toxicity. Anastomotic leakage rates were found to be similar between groups. Our study demonstrates a survival advantage of the use of HIPEC as a prophylactic strategy and suggests that patients whose disease burden is limited to positive cytology and limited nodal involvement may benefit the most from HIPEC. For patients with extensive carcinomatosis, the completeness of cytoreductive surgery is a critical prognostic factor for survival. Future RCTs should better define patient selection criteria.
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影响因子：
2.7
作者：
Cui HB;Ge HE;Bai XY;Zhang W;Zhang YY;Wang J;Li X;Xing LP;Guo SH;Wang ZY
通讯作者：
Wang ZY
影响因子：
2.6
作者：
FUJIMURA, T;YONEMURA, Y;MIYAZAKI, I
通讯作者：
MIYAZAKI, I
影响因子：
2.2
作者：
DerSimonian R;Laird N
通讯作者：
Laird N
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
82.9
作者：
Cristescu, Razvan;Lee, Jeeyun;Aggarwal, Amit
通讯作者：
Aggarwal, Amit