腹腔化疗联合静脉化疗对卵巢癌患者预后影响的meta分析

Effect of intraperitoneal chemotherapy combined with intravenous chemotherapy on the prognosis of patients with ovarian cancer:a meta-analysis

目的系统评价腹腔化疗(IP)联合静脉化疗(IV)对卵巢癌患者预后的影响。方法检索PubMed、EMBASE、Cochrane Library、中国知网,检索时间为建库至2023年1月1日,收集关于采用IP、IV治疗卵巢癌的随机对照临床试验,其中研究组采用IP联合IV方式,对照组采用单纯IV方式,分析2组无进展生存期(PFS)、总生存期(OS)及不良反应发生率。结果共纳入7项研究,涉及4057例患者。meta分析结果显示,研究组PFS显著长于对照组,差异有统计学意义(HR=0.86,95%CI:0.77~0.95,P=0.004)。亚组分析结果显示,2组PFS比较,差异无统计学意义(HR=0.85,95%CI:0.68~1.05,P=0.12)。研究组OS长于对照组,差异有统计学意义(HR=0.89,95%CI:0.79~1.00,P=0.04)。研究组不良反应(≥3级)发生率低于对照组,差异有统计学意义(HR=1.22,95%CI:1.09~1.37,P=0.0008)。亚组分析结果显示,2组胃肠道不良反应、感染和血栓发生率比较,差异有统计学意义(P<0.05),但在血液学毒性和神经毒性发生率方面比较,差异无统计学意义(P>0.05)。结论IP联合IV可以延长卵巢癌患者生存期,延缓复发时间,但需警惕重度不良反应的发生。

Objective To systematically evaluate the effect of intraperitoneal chemotherapy(IP)combined with intra venous chemotherapy(IV)on the prognosis of patients with ovarian cancer.Methods PubMe d,EMBASE,Cochrane Library and CNKI were searched from inception to January 1,2023.Randomized controlled trials about IP and IV in the treatment of ovarian cancer were collected.The study group was treated with IP combined with IV,and the control group was treated with IV alone.The progression-free survival(PFS),overall survival(OS)and the incidence of adverse reactions were analyzed.Results A total of seven studies involving 4057 patients were included.The results of meta-analysis showed that the PFS of the study group was significantly longer than that of the control group,and the difference was statistically significant(HR=0.86,95%CI:0.77-0.95,P=0.004).The results of subgroup analysis showed that there was no significant difference in PFS between the two groups(HR=0.85,95%CI:0.68-1.05,P=0.12).The OS of the study group was longer than that of the control group,and the difference was statistically significant(HR=0.89,95%CI:0.79-1.00,P=0.04).The incidence of adverse reactions(≥grade 3)in the study group was lower than that in the control group,and the difference was statistically significant(HR=1.22,95%CI:1.09-1.37,P=0.0008).The results of subgroup analysis showed that there were significant differences in the incidence of gastrointestinal adverse reactions,infection and thrombosis between the two groups(P<0.05).However,there was no significant difference in the incidence of hematological toxicity and neurotoxicity(P>0.05).Conclusion IP combined with IV can prolong the survival time of patients with ovarian cancer and delay the recurrence time,but it is necessary to be alert to the occurrence of severe adverse reactions.