腹腔热灌注联合全身化疗治疗胃癌恶性腹水的疗效与安全性Meta分析

摘要

Objective:To evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy(HIPEC)combined with systemic chemotherapy(SC)in treatment of gastric cancer with malignant ascites.Methods:The rele-vant studies were retrieved from the databases of Cochrane Library,Embase,PubMed,Web of Science,CNKI,Wan-fang,VIP,CBM from the establishment time to September 2017.We selected literatures in accordance with the inclu-sion criteria.And valid data was extracted after accessing the quality of these studies.Odds ratio(OR)and hazard ra-tio(HR),as well as their respective 95％confidence interval(CI)were used as statistical indicators.Revman 5.3 software was used for this Meta－analysis.Results:Finally,9 studies were included,enrolling 693 patients with gastric cancer with malignant ascites.Compared with SC group,HIPEC plus SC group turned out to be of higher improvement in both short －term and long －term efficacy,such as complete response(28.75％vs 8.01％,OR=4.32,95％CI:2.72～6.87,P＜0.001),response rate(75.41％vs 45.15％,OR=3.76,95％CI:2.55～5.54,P＜0.001),disease control rate(94.57％vs 79.88％,OR=4.38,95％CI:2.57～7.44,P ＜ 0.001),overall survival(HR=0.78,95％CI:0.68～0.88,P＜0.001),progression－free survival(HR=0.72,95％CI:0.52～0.99,P=0.04).As for safety,there were no significant differences in adverse events between two groups(all P＞0.05).Con-clusion:The efficacy of HIPEC plus SC in the treatment of gastric cancer with malignant ascites was better than that of systemic chemotherapy alone.And the incidences of adverse events were not increased.However,it needs to be further verified by performing higher quality,larger sample and multicenter clinical trials.%目的:评估腹腔热灌注(hyperthermic intraperitoneal chemotherapy,HIPEC)联合全身化疗(systemic chemotherapy,SC)治疗胃癌恶性腹水疗效与安全性.方法:检索Cochrane Library、Embase、PubMed、Web of Sci-ence、中国知网、万方数据库、维普数据库、中国生物医学文献数据库至2017年9月.按照纳入标准筛选文献,评价文献质量并提取数据;以比值比(odds ratio,OR)、危险比(hazard ratio,HR)及各自95％可信区间(con-fidence interval,CI)作为统计效应量;采用Revman 5.3进行Meta分析.结果:最终纳入9个研究,共693例胃癌恶性腹水患者.Meta分析结果显示:近期疗效方面,与单纯全身化疗相比,腹腔热灌注联合全身化疗可显著提高完全缓解(28.75％vs 8.01％,OR=4.32,95％CI:2.72～6.87,P＜0.001)、有效率(75.41％vs 45.15％,OR=3.76,95％CI:2.55～5.54,P＜0.001)和疾病控制率(94.57％vs 79.88％,OR=4.38,95％CI:2.57～7.44,P＜0.001),且差异均有统计学意义;远期疗效方面,腹腔热灌注联合全身化疗可提高患者的总生存期(HR=0.78,95％CI:0.68～0.88,P＜0.001)和无进展生存期(HR=0.72,95％CI:0.52～0.99,P=0.04),差异也均有统计学意义;而在安全性方面,两组毒副反应发生率无明显差别(均P＞0.05).结论:腹腔热灌注联合全身化疗治疗胃癌恶性腹水的有效性优于单纯全身化疗,不增加毒副反应风险;但仍需开展更 高质量、大样本、多中心临床试验进一步验证.