进展期胃癌腹腔热灌注化疗临床疗效与安全性Meta分析

Meta-analysis of clinic effect and security of perioperative intraperitoneal hyperthermic perfusion chemotherapy treatment for radical resection of local advanced gastric cancer

目的：探讨进展期胃癌患者围术期腹腔热灌注化疗的临床疗效和安全性。方法：检索CNKI、中国生物医学文献光盘数据库（CBN）和维普中文期刊数据库中文资料库，以及MEDLINE、EMBASE、BIOSISpreviews和Cochrane图书馆临床对照试验资料库，发表时间为1985-01-2011-01，文献语种为英文和中文；以“胃癌、胃肿瘤、进展期、热灌注化疗和胃癌根治术”为检索词，应用Meta分析的方法，对国内外12篇随机对照研究文献进行定量综合，以胃癌根治术后行围术期腹腔热灌注化疗的患者为治疗组，以仅行胃癌根治术的患者为对照组，比较两组患者3年生存率的RR作为结局变量，分析腹腔热灌注化疗临床应用的安全性。结果：入选12篇文献，共2307例患者，其中治疗组991例，对照组1316例，合计RR=l_42，95％cI：1．30～1．55，胃癌根治术后行围术期腹腔热灌注化疗治疗组患者比仅行胃癌根治术的对照组患者3年生存率高1．42倍，敏感性分析证实本结论较为可靠。现有资料出现的潜在安全性问题较小，胃癌根治术后行围术期腹腔热灌注化疗的治疗组并发症发生率与仅行胃癌根治术的对照组均为19％，差异无统计学意义，P=0．96；两组死亡率均为4％，差异无统计学意义，P=0．98。结论：进展期胃癌围术期腹腔热灌注化疗可以提高生存率，并不增加术后并发症的发生率和死亡率，临床应用安全有效。

OBJECTIVE： To investigate the clinic effect and security of perioperative intraperitoneal hyperthermic perfusion chemotherapy （IHPC） treatment for radical resection of local advanced gastric cancer. METHODS..CNKI,Chi nese biomedical literature database （CBM） and Chongqing VIP Chinese Journal Databas, and English database such as MEDLINE, EMBASE controlled trials register, BIOSIS, previews, Cochrane Library of clinical were searched. Using gas tric cancer,gastric tumor, chemohyperthermic peritonel perfusion （CHPP）, intraperitoneal hyperthermic chemoperfusion （IHCP）,hyperthermic intraperitoneal chemotherapy （HIPEC）, cytoreductive surgery as search terms. The literature re leased from January 1985 to January 2011 in English and Chinese. We reviewed 12 randomized controlled trials about IH- PC in local advanced gastric cancer and made a meta-analysis. Patients administated by IHCP post gastric cancer radical re section were classifed for the treatment group, and patients only by radical gastrectomy classifed for the control group. The 3-year survival rate of of two groups with RR as the outcome variable was compared,and the safety of IHPC in clinical ap- plication was analyzed. RESULTS The 12 selected literature published from 1994--2010,patients with a total of 2 307 ca ses,of which 991 cases classifed for the treatment group, and 1 316 cases classifed for the the control group, the total RR= 1.42,95 CI（1. 30--1. 55）. These indicated that the 3 years survival rate of patients with gastric cancer treated bypostoperative IHPC post radical gastrectomy was 1.42 times higher than those patients with gastric cancer only under- went radical gastrectomy,sensitivity analysis confirmed the conclusions more reliable. Available information appears smal ler potential security issues. The incidence rate of complications （19% vsl9%, P = 0.96） and mortality （4M vs4%, P= 0.98） between the treatment group treated by postoperative IHPC post radical gastrectomy and the control group under went only radical gastrectomy showed no statistical difference. CONLUSIONS： The perioperative IHCP can improve the survival rate of advanced gastric cancer,does not increase the incidence of postoperative complications and mortality. Perio- perative IHCP is safe and effective clinical application for curative resection of local advanced gastric cancer.