细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）治疗胃癌腹膜转移的疗效：系统评价与Meta分析

Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis.

作者信息

Langellotti Lodovica, Fiorillo Claudio, D'Annibale Giorgio, Panza Edoardo, Pacelli Fabio, Alfieri Sergio, Di Giorgio Andrea, Santullo Francesco

机构信息

General Surgery Department, Catholic University of the Sacred Hearth, 00168 Rome, Italy.

Department of Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Hearth, 00168 Rome, Italy.

出版信息

Cancers (Basel). 2024 May 18;16(10):1929. doi: 10.3390/cancers16101929.

BACKGROUND

Peritoneal carcinomatosis is one of deadliest metastatic patterns of gastric cancer, being associated with a median overall survival (OS) of 4 months. Up to now, palliative systemic chemotherapy (pSC) has been the only recommended treatment. The aim of this study is to evaluate a potential survival benefit after CRS + HIPEC compared to pSC.

METHODS

A systematic review was conducted according to the PRISMA guidelines in March 2024. Manuscripts reporting patients with peritoneal carcinomatosis from gastric cancer treated with CRS + HIPEC were included. A meta-analysis was performed, comparing the survival results between the CRS + HIPEC and pSC groups, and the primary outcome was the comparison in terms of OS. We performed random-effects meta-analysis of odds ratios (ORs). We assessed heterogeneity using the Q2 statistic.

RESULTS

Out of the 24 papers included, 1369 patients underwent CRS + HIPEC, with a median OS range of 9.8-28.2 months; and 103 patients underwent pSC, with a median OS range of 4.9-8 months. CRS + HIPEC was associated with significantly increased survival compared to palliative systemic chemotherapy (-1.8954 (95% CI: -2.5761 to -1.2146; < 0.001).

CONCLUSIONS

CRS + HIPEC could provide survival advantages in gastric cancer peritoneal metastasis compared to pSC.

背景

腹膜癌病是胃癌最致命的转移模式之一，其总体中位生存期（OS）为4个月。到目前为止，姑息性全身化疗（pSC）一直是唯一推荐的治疗方法。本研究的目的是评估与pSC相比，细胞减灭术联合腹腔热灌注化疗（CRS + HIPEC）后潜在的生存获益。

方法

根据PRISMA指南于2024年3月进行了系统评价。纳入报告接受CRS + HIPEC治疗的胃癌腹膜癌病患者的手稿。进行了荟萃分析，比较CRS + HIPEC组和pSC组之间的生存结果，主要结局是OS方面的比较。我们对优势比（OR）进行了随机效应荟萃分析。我们使用Q2统计量评估异质性。

结果

在纳入的24篇论文中，1369例患者接受了CRS + HIPEC，中位OS范围为9.8 - 28.2个月；103例患者接受了pSC，中位OS范围为4.9 - 8个月。与姑息性全身化疗相比，CRS + HIPEC与显著提高的生存率相关（-1.8954（95%CI：-2.5761至-1.2146；<0.001）。