细胞减灭术和腹腔热灌注化疗联合结直肠癌肝转移灶治愈性治疗的腹膜转移：所有文献的系统评价和观察性研究的荟萃分析。
Cytoreductive surgery and HIPEC for peritoneal metastases combined with curative treatment of colorectal liver metastases: Systematic review of all literature and meta-analysis of observational studies.
机构信息
Dept. of Surgical Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
出版信息
Cancer Treat Rev. 2013 Jun;39(4):321-7. doi: 10.1016/j.ctrv.2012.11.003. Epub 2012 Dec 12.
OBJECTIVE
Assess the overall outcome in colorectal cancer (CRC) patients that present with a combination of peritoneal metastases (PM) and liver metastases (CRLM) after curative resection and hyperthermic intraperitoneal chemotherapy (HIPEC) in the current literature.
METHODS
A systematic literature search according to the PRISMA guidelines was conducted using the PubMed database of the U.S. National library of Medicine using the keywords: colorectal cancer, liver metastasis, extra-hepatic, peritoneal metastases, peritoneal carcinomatosis, cytoreductive surgery (CRS), HIPEC and combinations hereof. Papers focussing on CRS and HIPEC for PM combined with curative treatment of CRLM were included, provided sufficient information on survival outcomes could be extracted. Duplicate publications were excluded. Meta-analysis was performed using the method described by Tierney et al.
RESULTS
After screening and full-text assessment of 39 papers, six articles were included containing data on combined PM and CRLM in patients treated with curative resection of both sites and HIPEC or early postoperative intraperitoneal chemotherapy (EPIC). Three articles provided enough statistical information for meta-analysis. Pooled hazard ratio (HR) was extracted from survival curves and was 1.24 (CI 0.96-1.60). A comparison was made with patients presenting with isolated PM undergoing CRS and HIPEC and with patients with disseminated disease undergoing (modern) systemic chemotherapy.
CONCLUSIONS
In the absence of randomized controlled studies, we found in this systematic review and meta-analysis of patients with a combination of colorectal metastases in the liver as well as in the peritoneum show a trend towards a lower overall survival after curative resection and HIPEC, when compared to patients with isolated peritoneal metastases after CRS and HIPEC (pooled HR1.24, CI 0.96-1.60). However, patients with metastatic CRC show a tendency towards increased median overall survival after CRS and HIPEC combined with resection of liver metastases when compared to treatment with modern systemic chemotherapy.
目的
评估当前文献中根治性切除和腹腔内热灌注化疗（HIPEC）后结直肠癌（CRC）患者同时出现腹膜转移（PM）和肝转移（CRLM）的总体结果。
方法
根据美国国家医学图书馆 PubMed 数据库的 PRISMA 指南进行系统文献检索，使用以下关键词：结直肠癌、肝转移、肝外、腹膜转移、腹膜癌病、细胞减灭术（CRS）、HIPEC 及其组合。纳入的研究为针对同时伴有可治愈的 CRLM 的 PM 行 CRS 和 HIPEC 的研究，只要能够提取到生存结果的足够信息即可。排除重复发表的文章。使用 Tierney 等人描述的方法进行荟萃分析。
结果
经过筛选和对 39 篇论文的全文评估，纳入了 6 篇包含同时治疗两处部位且行 HIPEC 或术后早期腹腔内化疗（EPIC）的根治性切除术后同时伴有 PM 和 CRLM 的患者数据的文章。有 3 篇文章提供了足够的统计信息进行荟萃分析。从生存曲线中提取合并风险比（HR）为 1.24（CI 0.96-1.60）。将其与仅行 PM 行 CRS 和 HIPEC 的患者以及行（现代）全身化疗的播散性疾病患者进行比较。
结论
在缺乏随机对照研究的情况下，我们在这项对同时患有肝转移和腹膜转移的结直肠癌患者的系统回顾和荟萃分析中发现，与仅行腹膜转移行 CRS 和 HIPEC 的患者相比，根治性切除和 HIPEC 后总体生存率呈下降趋势（合并 HR1.24，CI 0.96-1.60）。然而，与现代全身化疗相比，CRS 和 HIPEC 联合肝转移切除的转移性 CRC 患者的中位总生存时间有增加的趋势。
Zotero 插件