细胞减灭术联合腹腔热灌注化疗（HIPEC）与细胞减灭术治疗卵巢癌患者的效果：系统评价和荟萃分析。
Effects of CytoReductive surgery plus hyperthermic IntraPEritoneal chemotherapy (HIPEC) versus CytoReductive surgery for ovarian cancer patients: A systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China.
出版信息
Eur J Surg Oncol. 2019 Mar;45(3):301-309. doi: 10.1016/j.ejso.2018.10.528. Epub 2018 Oct 24.
BACKGROUND
The effects of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) and CytoReductive Surgery (CRS) for ovarian cancer patients remain controversial.
METHODS
A systematic review and meta-analysis was conducted using PubMed, Embase and Web of Science databases to investigate Overall Survival (OS), Disease Free Survival (DFS) and adverse effects between HIPEC and CRS group.
RESULTS
In our overall analysis (13 studies), patients in the HIPEC group exhibited a significantly improved OS (HR = 0.56, 95% CI = 0.41-0.76, P < 0.01) and DFS (HR = 0.61, 95% CI = 0.48-0.77, P < 0.01). Subgroup analysis revealed improved OS (HR = 0.57, 95% CI = 0.40-0.83, P = 0.04) and DFS (HR = 0.61, 95% CI = 0.47-0.80, P < 0.01) for primary ovarian cancer in favour of HIPEC group. However, recurrent ovarian cancer patients who received HIPEC exhibited only significantly improved OS (HR = 0.48, 95% CI = 0.24-0.96, P < 0.01) but not DFS (HR = 0.59, 95% CI = 0.33-1.08, P = 0.09). In addition, both significantly improved OS and DFS were also observed in patients who received HIPEC in the subgroups based on the following factors: studies published before 2015, studies with ≥100 total patients, a single drug used for HIPEC, 90-min HIPEC duration and a regimen of CRS plus HIPEC followed by chemotherapy. Moreover systematically reviewed toxicity, morbidity, mortality and long-term outcomes were tolerable after HIPEC.
CONCLUSIONS
The addition of HIPEC to CRS could significantly improve OS of ovarian cancer patients, albeit optimal drug regimen is not clear.
背景
对于卵巢癌患者，高热腹腔内化疗（HIPEC）和细胞减灭术（CRS）的效果仍存在争议。
方法
使用 PubMed、Embase 和 Web of Science 数据库进行系统评价和荟萃分析，以调查 HIPEC 组与 CRS 组之间的总生存率（OS）、无病生存率（DFS）和不良反应。
结果
在我们的总体分析中（13 项研究），HIPEC 组患者的 OS（HR=0.56，95%CI=0.41-0.76，P<0.01）和 DFS（HR=0.61，95%CI=0.48-0.77，P<0.01）均显著改善。亚组分析显示，原发性卵巢癌患者的 OS（HR=0.57，95%CI=0.40-0.83，P=0.04）和 DFS（HR=0.61，95%CI=0.47-0.80，P<0.01）显著改善，有利于 HIPEC 组。然而，接受 HIPEC 的复发性卵巢癌患者仅 OS 显著改善（HR=0.48，95%CI=0.24-0.96，P<0.01），DFS 无显著改善（HR=0.59，95%CI=0.33-1.08，P=0.09）。此外，在基于以下因素的亚组中，接受 HIPEC 的患者的 OS 和 DFS 均显著改善：发表于 2015 年之前的研究、总患者数≥100 人的研究、用于 HIPEC 的单一药物、90 分钟 HIPEC 持续时间以及 CRS 加 HIPEC 后化疗的方案。此外，系统回顾了毒性、发病率、死亡率和 HIPEC 后的长期结果是可耐受的。
结论
在 CRS 中加入 HIPEC 可显著改善卵巢癌患者的 OS，但最佳药物方案尚不清楚。
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