术中辅助性腹腔内温热灌注化疗在胃癌治疗中应用的Meta分析

Analysis on hyperthermic intraoperative intraperitoneal chemotherapy for resectable gastric cancer

目的比较术中辅助性腹腔温热灌注化疗在胃癌治疗中的安全性及有效性。方法计算机检索中国知网、Pubmed、ScienceDirect、Highwire等数据库1998—2010年有关术中应用辅助性腹腔内温热灌注化疗与否的随机对照试验(RCT),评价纳入研究的质量后,提取有效数据,采用Review Manager 4.2软件进行Meta分析。结果经过筛选10篇文章纳入,其中9篇用于胃癌根治术后生存率的分析,6篇用于局部腹腔转移率的分析,8篇用于术后并发症的分析,共1435例胃癌根治术。Meta分析结果示,术中灌注化疗组与非化疗组术后并发症无统计学意义。术中腹腔内温热温灌注化疗明显改善患者的3年生存率(OR=0.54,95%CI=0.36～0.81,P=0.003),同时能够降低术后患者的局部复发(OR=0.34,95%CI=0.23～0.48,P<0.01)。结论术中腹腔内温热灌注化疗能降低胃癌患者的局部复发率,提高3年生存率。

Objective To determine the effectiveness and safety of hyperthermic intra-operative intra-peritoneal chemotherapy（HIIC）for patients with locally advanced resectable gastric cancer.Methods CNKI,Pubmed,ScienceDirect,Highwire and other databases were searched for the randomized controlled trials（RCT）relevant to patients with gastric cancer were randomly assigned to receive surgery combined with HIIC versus surgery without HIIC between 1998 and 2010.After independent quality assessment and data extraction,data was pooled for meta-analysis.Results Ten references of randomized controlled trials（RCT）were included for quality appraisal and data extraction.Eight references were judged to be of fair quality and subjected to meta-analysis.A significant improvement in 3 year’s survival was associated with hyperthermic intraoperative intraperitoneal chemotherapy（HIIC）alone（OR=0.54,95% CI=0.36-0.81,P=0.003）.There was a trend towards local-regional recurrence and peritoneal metastases improvement with HIIC combined surgery（OR=0.35,95% CI=0.23-0.48,P〈0.01）.Conclusion The present meta-analysis indicates that HIIC after resection of advanced gastric primary cancer is associated with improved 3 year’s survival.