Zhao Peng-Yue, Hu Shi-Dong, Li Yu-Xuan, Yao Ren-Qi, Ren Chao, He Chang-Zheng, Li Song-Yan, Wang Yu-Feng, Yao Yong-Ming, Huang Xiao-Hui, Du Xiao-Hui
Department of General Surgery, First Medical Center of Chinese People's Liberarion Army General Hospital, Beijing, China.
Trauma Research Center, Fourth Medical Center of the Chinese People's Liberarion Army General Hospital, Beijing, China.
Front Surg. 2020 Nov 17;7:590452. doi: 10.3389/fsurg.2020.590452. eCollection 2020.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective measure for improving the prognosis of colorectal cancer (CRC) patients with peritoneal carcinomatosis (PC). However, the role of HIPEC in CRC patients at high risk of PC remains controversial. The current systematic review and meta-analysis aimed to evaluate the clinical efficacy and safety of HIPEC in CRC patients at high risk of PC. We performed a systematic search of PubMed, Embase, Cochrane Library, and other online databases up to July 30, 2020. The clinical data, including overall survival, disease free survival, peritoneal metastasis rate, and postoperative adverse reaction were screened and analyzed after data extraction. Risk ratios (RRs) were applied to analyze these dichotomous outcomes with a random effects model. A total of 6 available clinical studies involving 603 patients were finally included. CRC patients at high risk of PC who proactively underwent HIPEC treatment showed a significantly reduced peritoneal metastasis rate (RR: 0.41, 95% CI: 0.21-0.83, = 0.01; = 58%) compared to the similarly high-risk in CRC patients who did not receive HIPEC treatment. However, in terms of overall survival (RR: 1.13, 95% CI: 0.97-1.33, = 0.12; = 77%), disease-free survival (RR: 1.10, 95% CI: 0.75-1.59, = 0.63; = 53%), progression free survival (RR: 1.85, 95% CI: 0.48-7.14, = 0.37; = 93%), and postoperative adverse reactions (RR: 0.1.07, 95% CI: 0.36-3.15, = 0.90; = 78%), there was no significant difference between the HIPEC treatment and control groups. Proactive HIPEC treatment did not show the expected clinical efficacy in prolonging the overall survival time, disease-free survival time, and progression-free survival time of CRC patients at high risk of PC. However, the preemptive administration of HIPEC was associated with a reduced peritoneal metastasis rate and did not cause adverse additional postoperative effects.
热灌注化疗（HIPEC）是改善结直肠癌（CRC）合并腹膜转移癌（PC）患者预后的有效措施。然而，HIPEC在PC高危CRC患者中的作用仍存在争议。本系统评价和荟萃分析旨在评估HIPEC在PC高危CRC患者中的临床疗效和安全性。我们对截至2020年7月30日的PubMed、Embase、Cochrane图书馆和其他在线数据库进行了系统检索。在数据提取后，对包括总生存期、无病生存期、腹膜转移率和术后不良反应在内的临床数据进行筛选和分析。应用风险比（RRs）通过随机效应模型分析这些二分结果。最终纳入6项可用的临床研究，共603例患者。与未接受HIPEC治疗的PC高危CRC患者相比，主动接受HIPEC治疗的PC高危CRC患者腹膜转移率显著降低（RR：0.41，95%CI：0.21-0.83，P=0.01；I²=58%）。然而，在总生存期（RR：1.13，95%CI：0.97-1.33，P=0.12；I²=77%）、无病生存期（RR：1.10，95%CI：0.75-1.59，P=0.63；I²=53%）、无进展生存期（RR：1.85，95%CI：0.48-7.14，P=0.37；I²=93%）和术后不良反应（RR：1.07，95%CI：0.36-3.15，P=0.90；I²=78%）方面，HIPEC治疗组与对照组之间无显著差异。主动进行HIPEC治疗在延长PC高危CRC患者的总生存时间、无病生存时间和无进展生存时间方面未显示出预期的临床疗效。然而，预防性应用HIPEC可降低腹膜转移率，且未引起额外的术后不良影响。
