Yap Daniel Ren Yi, Wong Jolene Si Min, Tan Qiu Xuan, Tan Joey Wee-Shan, Chia Claramae Shulyn, Ong Chin-Ann Johnny
Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
Front Oncol. 2021 Dec 3;11:795390. doi: 10.3389/fonc.2021.795390. eCollection 2021.
Peritoneal metastasis (PM) is a late-stage manifestation of intra-abdominal malignancies. The current standard of care indicates that cure can only be achieved with cytoreductive surgery (CRS) which is often indicated with concurrent adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC). However, the utility of HIPEC within subsets of PM is not fully understood. We seek to compare the effectiveness of HIPEC in improving peritoneal recurrence rates in PM of different origins.
We conducted a systematic review of trials on the PubMed, EMBASE, and Cochrane databases, last searched in August 2021. Biases were assessed using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials as well as the Methodological Index for Non-Randomized Studies (MINORS) framework.
7 gastric PM studies, 3 ovarian PM studies, and 3 colorectal PM studies were included. Recurrence-free survival was improved in the HIPEC + CRS cohort in 5 gastric trials but only 1 ovarian trial and none of colorectal origin.
Our findings indicate decent effectiveness of HIPEC in gastric PM, but limited utility in ovarian and colorectal PM. Limitations in the current literature are attributed to the paucity of data available, a lack of homogeneity and consideration of novel and personalised treatment regimens. We implore for further studies to be conducted with a focus on patient selection and stratification, and suggest a reframing of approach towards modern molecular and targeted therapeutic options in future studies of HIPEC.
https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/60c1ffff0c1b78001e8efbe3/, identifier reviewregistry1166.
腹膜转移（PM）是腹内恶性肿瘤的晚期表现。当前的治疗标准表明，只有通过细胞减灭术（CRS）才能实现治愈，而细胞减灭术通常与同期辅助腹腔内热化疗（HIPEC）联合使用。然而，HIPEC在PM亚组中的效用尚未完全明确。我们旨在比较HIPEC在改善不同起源的PM腹膜复发率方面的有效性。
我们对PubMed、EMBASE和Cochrane数据库进行了系统综述，最后一次检索时间为2021年8月。使用Cochrane协作网评估随机试验偏倚风险的工具以及非随机研究方法学指数（MINORS）框架评估偏倚。
纳入了7项胃PM研究、3项卵巢PM研究和3项结直肠PM研究。在5项胃PM试验中，HIPEC + CRS队列的无复发生存期得到改善，但卵巢PM试验中只有1项，结直肠起源的试验中无一例。
我们的研究结果表明，HIPEC在胃PM中具有较好的有效性，但在卵巢和结直肠PM中的效用有限。当前文献的局限性归因于可用数据的匮乏、缺乏同质性以及对新型和个性化治疗方案的考虑。我们恳请开展进一步研究，重点关注患者选择和分层，并建议在未来HIPEC研究中重新构建对现代分子和靶向治疗方案的方法。
