进展期胃癌术后早期腹腔灌注化疗对患者生存期和复发率影响的Meta分析

Impact of Early Postoperative Intraperitoneal Chemotherapy on Clinical Survival and Recurrence Rates in Treatment of Advanced Gastric Cancer:A Meta Analysis

目的探讨术后早期腹腔灌注化疗在进展期胃癌治疗中的作用。方法计算机检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,检索时间从各数据库建库至2010年9月;同时辅助其他检索,纳入胃癌术后早期腹腔灌注化疗治疗进展期胃癌的随机对照试验(RCT)。由两名评价者独立评价纳入研究的质量并提取资料,并用RevMan 5.0软件进行统计分析。结果共纳入9篇RCT,共1 171例患者。Meta分析结果显示:与单纯全身静脉化疗比较,术后早期腹腔灌注化疗可以提高进展期胃癌患者的1、2、3、5年生存率,也可以降低患者2、3年复发率及腹腔内复发率,同时亦可以降低患者恶心呕吐的发生率,减轻患者的骨髓抑制和肝肾功能损害。结论进展期胃癌术后早期腹腔灌注化疗可以提高患者生存率,减少术后复发率,减轻化疗的毒副作用。

Objective To evaluate the effects of early postoperative intraperitoneal chemotherapy in the treatment of advanced gastric cancer.Methods We searched Cochrane Library,PubMed,EMBASE,Chinese Biomedical Literature Database,China Academic Journal,Chinese Science and Technology Journal Full-text database for literatures published between the establishment of these databases and September 2010.We also traced related references and experts in this field,as well as communicated with other authors to obtain certain information that had not been found.Randomized controlled trials of early postoperative intraperitoneal chemotherapy in treatment of gastric cancer were included.We evaluated the quality of these studies and analyzed the data by Cochrane Collaboration＇s RevMan 5.0 software.Results Nine RCTs（1171 patients altogether） were included.Meta-analysis results showed that compared with intravenous chemotherapy alone,early postoperative intraperitoneal chemotherapy improved 1,2,3 and 5-year survival rates and reduced 2 and 3-year relapse rates and intra-abdominal recurrence.Meanwhile,early postoperative intraperitoneal chemotherapy reduced the incidence of nausea and vomiting and displayed a protective effect on liver function and renal function.Conclusion Compared with intravenous chemotherapy,early postoperative intraperitoneal chemotherapy improves survival rate and reduces both recurrence rate and toxic side effects in advanced gastric cancer patients.