Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
São João University Medical Center, Centro de Responsabilidade Integrado de Obesidade (CRIO), Porto, Portugal.
Ann Surg Oncol. 2022 Nov;29(12):7528-7537. doi: 10.1245/s10434-022-12312-7. Epub 2022 Aug 5.
Despite promising results, the effectiveness of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with gastric cancer with peritoneal carcinomatosis (GCPC) has not been systematically evaluated. The aim of this systematic review is to compare the survival, complications and risk of recurrence between CRS + HIPEC versus CRS alone in GCPC.
A systematic review was performed in MEDLINE and Web of Science according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Primary studies with patients with GCPC older than 18 years were included. Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess the quality of the studies. We performed random-effects meta-analysis of risk ratios (RR). We assessed heterogeneity using the I statistic.
Five studies were included in the qualitative and four in the quantitative analysis. The overall survival (OS) rate after 1 year was 3.65 times higher for CRS + HIPEC than CRS alone [RR = 3.65, 95% confidence interval (95% CI) = 1.01-13.26, I = 73%]. The OS rate after 5 years was more than three times higher for CRS + HIPEC than for CRS alone (RR = 3.25, 95% CI = 1.28-8.26, I = 8%). No significant differences between CRS + HIPEC and CRS alone related to complications were found (RR = 1.05, 95% CI = 0.83-1.33, I = 0%). The risk of peritoneal recurrence was significantly lower for CRS + HIPEC than for CRS alone (RR = 0.23, 95% CI = 0.11-0.48, I = 40%). The results may be associated with some information or indication bias.
Results should be analysed cautiously given the detected heterogeneity and limitations of included studies. However, treatment with CRS + HIPEC seems to increase the survival of patients with GCPC, more than treatment with CRS alone, decrease the risk of peritoneal recurrence and not be associated with more complications.
尽管有很有前景的结果，但细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）在胃癌伴腹膜转移（GCPC）患者中的有效性尚未得到系统评估。本系统评价的目的是比较 CRS+HIPEC 与单独 CRS 治疗 GCPC 患者的生存、并发症和复发风险。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，在 MEDLINE 和 Web of Science 中进行了系统评价。纳入了年龄大于 18 岁的 GCPC 患者的原始研究。采用非随机研究方法学指数（MINORS）标准评估研究质量。我们对风险比（RR）进行了随机效应荟萃分析。我们使用 I 统计量评估异质性。
五项研究进行了定性分析，四项研究进行了定量分析。与单独 CRS 相比，CRS+HIPEC 后 1 年的总体生存率（OS）提高了 3.65 倍[RR=3.65，95%置信区间（95%CI）=1.01-13.26，I=73%]。与单独 CRS 相比，CRS+HIPEC 后 5 年的 OS 率提高了三倍以上（RR=3.25，95%CI=1.28-8.26，I=8%）。未发现 CRS+HIPEC 与单独 CRS 相关的并发症之间存在显著差异（RR=1.05，95%CI=0.83-1.33，I=0%）。与单独 CRS 相比，CRS+HIPEC 的腹膜复发风险显著降低（RR=0.23，95%CI=0.11-0.48，I=40%）。结果可能与一些信息或指示偏倚有关。
鉴于所检测到的异质性和纳入研究的局限性，结果应谨慎分析。然而，与单独 CRS 治疗相比，CRS+HIPEC 似乎可以提高 GCPC 患者的生存率，降低腹膜复发风险，且不增加并发症。
