Chen Ruijian, Yang Zifeng, Li Renjie, Yang Yuesheng, Zheng Jiabin, Wang Junjiang, Li Yong
Shantou University Medical College, Shantou, Guangdong, P. R. China.
Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2025 Jun 15;13:goaf040. doi: 10.1093/gastro/goaf040. eCollection 2025.
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a promising therapeutic approach for treating advanced gastric cancer with peritoneal metastases. Herein, we conducted this meta-analysis to evaluate the feasibility, efficacy, and safety of PIPAC in this patient population. The literature between January 2011 and February 2024 was comprehensively searched on the following databases: PubMed, Embase, Web of Science, and the Cochrane Library. The search, guided by the Population-Intervention-Comparison-Outcome (PICO) framework, focused on studies reporting on the feasibility, efficacy, and safety of PIPAC. Data were pooled by using log transformation (PLN) or Freeman-Tukey double arcsine transformation. Of the 451 initially identified studies, 18 were included in the meta-analysis, comprising 671 patients who underwent 1,357 PIPAC procedures. Our data analysis indicated that 32.6% of the patients (95% confidence interval [CI], 23.5%-42.3%) completed three or more PIPAC procedures. Conversely, 2.3% of patients (95% CI, 0.6%-5%) either did not have access to or could not undergo PIPAC. The average rate of histological response across the included studies was 66.3% (95% CI, 59.1%-73.1%). Pooled results showed that 13.1% of patients (95% CI, 7.0%-20.7%) had reduced ascites after PIPAC, and 7.8% (95% CI, 4.8%-11.4%) became resectable. Adverse events were reported in 17.1% of patients (95% CI, 5.3%-33.4%), with 3.6% (95% CI, 1.4%-6.6%) experiencing severe adverse events (grade 3-5, Common Terminology Criteria for Adverse Events [CTCAE]). The pooled mortality related to PIPAC was 0.1% (95% CI, 0%-0.5%). The pooled proportions for 6-month, 1-year, and 2-year overall survival rates were 82.4% (95% CI, 69.2%-92.8%), 54.0% (95% CI, 45.7%-62.3%), and 20.0% (95% CI, 11.3%-30.3%), respectively. The average median overall survival was 11.7 months (95% CI, 9.3-14.0 months). Our study suggests that most patients can benefit from PIPAC treatment, such as improved quality of life and significantly longer median overall survival. Patients who received first-line chemotherapy prior to PIPAC and concomitant systemic chemotherapy during PIPAC treatment, and who underwent the PIPAC procedure on more than three occasions, exhibited a more favorable survival prognosis.
腹腔内热灌注化疗（PIPAC）已成为治疗伴有腹膜转移的晚期胃癌的一种有前景的治疗方法。在此，我们进行了这项荟萃分析，以评估PIPAC在该患者群体中的可行性、疗效和安全性。在2011年1月至2024年2月期间，我们在以下数据库中全面检索了文献：PubMed、Embase、Web of Science和Cochrane图书馆。在人群-干预-对照-结局（PICO）框架的指导下进行检索，重点关注报告PIPAC可行性、疗效和安全性的研究。使用对数转换（PLN）或弗里曼-图基双反正弦转换对数据进行合并。在最初确定的451项研究中，18项被纳入荟萃分析，包括671例接受了1357次PIPAC治疗的患者。我们的数据分析表明，32.6%的患者（95%置信区间[CI]，23.5%-42.3%）完成了三次或更多次PIPAC治疗。相反，2.3%的患者（95%CI，0.6%-5%）无法接受或不能进行PIPAC治疗。纳入研究的组织学反应平均率为66.3%（95%CI，59.1%-73.1%）。汇总结果显示，13.1%的患者（95%CI，7.0%-20.7%）在PIPAC治疗后腹水减少，7.8%（95%CI，4.8%-11.4%）的患者变为可切除。17.摘要1%的患者报告了不良事件（95%CI，5.3%-33.4%），3.6%（95%CI，1.4%-6.6%）的患者经历了严重不良事件（3-5级，不良事件通用术语标准[CTCAE]）。与PIPAC相关的汇总死亡率为0.1%（95%CI，0%-0.5%）。6个月、1年和2年总生存率的汇总比例分别为82.4%（95%CI，69.2%-92.8%）、54.0%（95%CI，45.7%-62.3%）和20.0%（95%CI，11.3%-30.3%）。平均总生存期中位数为11.7个月（95%CI，9.3-14.0个月）。我们的研究表明，大多数患者可以从PIPAC治疗中获益，如生活质量改善和总生存期中位数显著延长。在PIPAC治疗前接受一线化疗且在PIPAC治疗期间接受同步全身化疗以及接受PIPAC治疗超过三次的患者，生存预后更有利。
