Academic Department of Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
Br J Surg. 2011 Sep;98(9):1225-35. doi: 10.1002/bjs.7586. Epub 2011 Jun 6.
Gastric cancer with peritoneal carcinomatosis has a poor prognosis. Intraperitoneal chemotherapy has been proposed as a treatment option. This systematic review examined recent literature to determine the role of intraperitoneal chemotherapy in gastric cancer.
Four electronic databases were searched between January 2004 and January 2010 for relevant studies. Defined outcomes of interest were treatment-related morbidity and mortality, long-term survival and sites of recurrence.
Fourteen studies were identified involving 914 patients with gastric cancer, of whom 819 (89·6 per cent) received intraperitoneal chemotherapy. There were two randomized controlled trials, two case-control studies and ten observational studies. Methodological quality was rated as poor in 12 studies, with selection and observer bias apparent in most non-randomized cohorts. Studies were often small and varied in terms of intraperitoneal timing of chemotherapy, chemotherapeutic agents, treatment temperature, and the use of adjuvant therapies. In the better conducted studies, survival was longer in patients receiving intraperitoneal chemotherapy and surgery than in those having surgery alone.
There is limited good-quality evidence to determine the role of intraperitoneal chemotherapy in gastric cancer. Intraperitoneal chemotherapy in gastric cancer is worthy of further appraisal. However, the quality of trials must be improved, and studies must be conducted more uniformly to minimize bias and aid comparison between centres.
患有腹膜转移癌的胃癌预后较差。腹腔内化疗已被提议作为一种治疗选择。本系统综述检查了最近的文献，以确定腹腔内化疗在胃癌中的作用。
2004 年 1 月至 2010 年 1 月期间，四个电子数据库搜索了相关研究。定义的感兴趣的结局是与治疗相关的发病率和死亡率、长期生存和复发部位。
确定了 14 项涉及 914 例胃癌患者的研究，其中 819 例（89.6％）接受了腹腔内化疗。有两项随机对照试验、两项病例对照研究和十项观察性研究。12 项研究的方法学质量被评为较差，大多数非随机队列中存在选择和观察者偏倚。研究往往规模较小，在腹腔内化疗时机、化疗药物、治疗温度以及辅助治疗的使用方面存在差异。在实施较好的研究中，接受腹腔内化疗和手术的患者比单独手术的患者生存时间更长。
有有限的高质量证据来确定腹腔内化疗在胃癌中的作用。腹腔内化疗在胃癌中值得进一步评估。然而，必须提高试验的质量，并更一致地进行研究，以尽量减少偏倚并有助于中心之间的比较。
