细胞减灭术联合腹腔热灌注化疗治疗胃癌腹膜转移的系统评价

摘要

目的:系统评价细胞减灭术(cytoreductive surgery,CRS)联合腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗胃癌伴腹膜转移患者的临床有效性和安全性,为临床应用与深入研究提供参考.方法:计算机检索PubMed、Cochrane图书馆、EMbase、MEDLINE(Ovid)、CNKI、维普中刊数据库、中国生物医学文献数据库,收集利用CRS联合HIPEC治疗胃癌伴腹膜转移患者的所有研究,包括随机对照试验(randomized controlled trail,RCT)和非随机对照试验(non-randomized controlled trail,非RCT),对纳入研究主要从生存期和安全性两方面进行统计分析.结果:纳入1项RCT和8项非RCT,共504例患者.生存期方面,RCT中,CRS联合HIPEC组的中位生存期为11个月,明显高于单纯CRS组的7个月(P=0.003).8项非RCT中,CRS联合HIPEC治疗的1、2、3年合计总体生存率分别为52.9%、27.1%、16.8%.手术切除程度达到CC 0~1分是预后较好的预测指标.安全性方面,非RCT显示联合治疗方案围手术期总体死亡率为4.8%,严重并发症的合计发生率为24.9%,在RCT中这两项数据分别为0和13.1%.结论:对于胃癌伴腹膜转移,尤其是达到CC 0~1切除的患者,CRS联合HIPEC能延长患者的生存期,但同时存在较高的严重并发症发生率.%Objective:To systematically review the effectiveness and safety of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis from gastric cancer,so as to provide references for clinical practice and studies.Methods:We electronically searched PubMed,EMDLINE(Orib),The Cochrane Library,EMbase,CBM,VIP and CNKI for randomized controlled trials (RCTs) and non-randomized controlled trials about cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer up to December,31 2015.All included studies were analyzed mainly in two aspects:survival and safety.Results:A total of 1 RCT and 8 non-RCTs involving 504 patients were included.The overall 1,2,and 3 years survival of CRS plus HIPEC from 8 non-RCTs was 52.9%,27.1%,16.8%,respectively.In the only one RCT,the median survival time was 11 months in CRS plus HIPEC group compared to 7 months in CRS group (P=0.003).CC 0~1 was a prognostic factor for better survival.In respect to safety,mortality and morbidity rates in 8 non-RCTs were 4.8% and 24.9%,respectively,while 0 and 13.1% in the RCT.Conclusion:Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy could prolong the survival time in selected gastric cancer with peritoneal metastasis patients.Especially whose CC score was 0~1.However,the procedure was also correlated with a higher mortality and morbidity rates.