Wang Tianqi, Ma Shengjie, Zhang Shiwei, Aizezi Yilihaer, Wang Quan
Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China.
Front Oncol. 2024 Nov 12;14:1466473. doi: 10.3389/fonc.2024.1466473. eCollection 2024.
Peritoneal metastasis is one of the most common modes of spread of gastric cancer. Currently, surgical treatment combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and systemic chemotherapy has demonstrated promising outcomes in both the treatment and prevention of peritoneal metastasis in gastric cancer. However, various HIPEC drug regimens are in clinical use, and their efficacy remains unclear. This study aims to evaluate the effectiveness of different HIPEC drug regimens in patients with advanced gastric cancer to determine the optimal therapeutic approach.
This study conducted a systematic review and Bayesian network meta-analysis. Patients in the experimental group underwent surgery combined with HIPEC and chemotherapy. The search period covered literature from database inception to June 1, 2024. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to evaluate overall survival (OS) as the primary outcome. Odds ratios (ORs) with 95% CIs were used to assess overall disease recurrence, peritoneal recurrence, and postoperative morbidity as secondary outcomes. To ensure scientific rigor and transparency, this study has been registered with PROSPERO (CRD42024533948).
A total of 11 randomized controlled trials (RCTs) involving 1092 patients were included. Compared to surgery combined with chemotherapy, the regimens of cisplatin (HRs = 0.52, 95% CI: 0.38-0.73), mitomycin C (HRs = 0.99, 95% CI: 0.55-1.79), cisplatin plus fluorouracil (HRs = 0.60, 95% CI: 0.38-0.95), and oxaliplatin plus 5-fluorouracil (HRs = 0.53, 95% CI: 0.36-0.78) all demonstrated benefits in OS. The cisplatin (ORs = 0.16, 95% CI: 0.03-0.60) and mitomycin C (ORs = 0.03, 95% CI: 0-0.71) regimens also showed advantages in reducing peritoneal recurrence, with no impact on postoperative morbidity. Importantly, the cisplatin regimen was superior to other regimens in terms of OS and overall disease recurrence, achieving a balance between efficacy and safety.
Compared to chemotherapy alone, HIPEC treatment shows significant benefits in OS without a notable disadvantage in postoperative morbidity. Although no single HIPEC regimen demonstrated clear benefits across all outcomes, the cisplatin regimen performed well in multiple aspects, indicating its potential for further research and clinical application.
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=533948, identifier CRD42024533948.
腹膜转移是胃癌最常见的扩散方式之一。目前，手术治疗联合腹腔内热灌注化疗（HIPEC）和全身化疗在胃癌腹膜转移的治疗和预防方面已显示出有前景的结果。然而，各种HIPEC药物方案正在临床使用，其疗效仍不明确。本研究旨在评估不同HIPEC药物方案对晚期胃癌患者的有效性，以确定最佳治疗方法。
本研究进行了系统评价和贝叶斯网络荟萃分析。实验组患者接受手术联合HIPEC和化疗。检索期涵盖从数据库建立到2024年6月1日的文献。采用风险比（HRs）及95%置信区间（CIs）评估总生存期（OS）作为主要结局。采用比值比（ORs）及95% CIs评估总疾病复发、腹膜复发和术后发病率作为次要结局。为确保科学严谨性和透明度，本研究已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42024533948）。
共纳入11项随机对照试验（RCT），涉及1092例患者。与手术联合化疗相比，顺铂方案（HRs = 0.52，95% CI：0.38 - 0.73）、丝裂霉素C方案（HRs = 0.99，95% CI：0.55 - 1.79）、顺铂加氟尿嘧啶方案（HRs = 0.60，95% CI：0.38 - 0.95）和奥沙利铂加5 - 氟尿嘧啶方案（HRs = 0.53，95% CI：0.36 - 0.78）在OS方面均显示出益处。顺铂方案（ORs = 0.16，95% CI：0.03 - 0.60）和丝裂霉素C方案（ORs = 0.03，95% CI：0 - 0.71）在减少腹膜复发方面也显示出优势，且对术后发病率无影响。重要的是，顺铂方案在OS和总疾病复发方面优于其他方案，在疗效和安全性之间取得了平衡。
与单纯化疗相比，HIPEC治疗在OS方面显示出显著益处，且术后发病率无明显劣势。尽管没有单一的HIPEC方案在所有结局方面都显示出明显益处，但顺铂方案在多个方面表现良好，表明其具有进一步研究和临床应用的潜力。
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=533948，标识符CRD42024533948。
