CRS联合HIPEC治疗晚期及复发性上皮性卵巢癌疗效的系统评价与Meta分析

Effects of Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy in Advanced and Recurrent Ovarian Cancer: A Systematic Review and Meta-analysis

目的：系统评价肿瘤细胞减灭术联合腹腔内热灌注化疗在晚期及复发性上皮性卵巢癌中应用的疗效。方法：采用计算机检索Cochrane图书馆、Pub Med、Embase、美国临床肿瘤（American Society of Clinical Oncology,ASCO）和欧洲肿瘤内科学会（European Society for Medical Oncology,ESMO）、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方数据库,时间为1998年1月至2014年11月,纳入肿瘤细胞减灭术联合腹腔内热灌注化疗与传统方法比较治疗晚期及复发性上皮性卵巢癌的临床对照试验,由2名评价者独立按NOS标准评价纳入观察性研究的质量,按Cochrane偏倚风险评估工具评价纳入随机对照试验的质量,并采用Cochrane协作网提供的Rev Man 5.3软件进行Meta分析,合并值为风险比（HR）。结果：纳入9项研究共731例患者,其中1项为随机对照研究,其余8项为观察性研究,Meta分析结果显示,与传统治疗相比,肿瘤细胞减灭术联合腹腔内热灌注化疗能够延长晚期及复发性卵巢癌的无疾病生存期（HR=0.39,95%CI 0.27~0.56）及总生存期（HR=0.39,95%CI 0.29~0.53）,差异有统计学意义。结论：目前的证据表明,CRS联合HIPEC能够改善晚期及复发性上皮性卵巢癌的生存期,但由于观察性研究固有的缺陷,其疗效仍需要大型、多中心、前瞻性的随机对照试验来验证,因此就目前的证据来说,建议对CRS联合HIPEC的临床应用持审慎的态度。

Objective To evaluate the efficacy of eytoreductive surgery combined with hyperthermic intraperitoneal chemo- therapy in patients with advanced and recurrent ovarian cancer. Methods We searched the Cochrane Library,PubMed, Em- hase,ASCO,ESMO,CBM,CNKI and Wanfang detebases for studies published from 1998 to 2014 that evaluated the effects of cytoreduetive surgery and hyperthermic intraperitoneal chemotherapy in patients advanced and recurrent ovarian cancer. Two valuators independently retrieved clinical controled trails according to the inclusive and exclusive criteria, assessed the methodological quality of included trials, and extracted date. Meta analysis was performed by RevMan 5.3 software. Results Nine studies involving 731 patients were ultimately included. The results of meta-analyses showed that cytoreductive surgery with hyperthermie intraperitoneal chemotherapy can prolonged PFS （ HR = 0.39,95% CI = 0.27 ~ 0.56 ） and OS （ HR = O. 39,95% C1 = O. 29 ~ O. 53 ） , the differences between two groups had significant difference. The heterogeneity and publica- tion bias in the enrolled studies were within acceptable thresholds. Conclusion The existing evidence demonstrated the com- bination of CRS and HIPEC could improve PFS and OS in patients with advanced and recurrent ovarian cancer. However, due to the limitations of the ease-control studies, further randomized trials are warranted to confirm these results.