Efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer:a Meta-analysis / 肿瘤研究与临床

ABSTRACT

Objective To evaluate the efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer (AGC). Methods The related randomized controlled trials were searched in the following databases such as Cochrane Library, PubMed, Web of Science from database establishment to April 2017. Data extraction and quality assessment by means of NOS were completed by two researchers.The survival rate,recurrence rate,mortality and morbidity were analyzed by RevMan 5.3 software. Results Seventeen literatures which were strictly filtrated from the original 2 383 literatures were included for Meta-analysis and the NOS score was 6-8. A total of 2 302 AGC cases were included to divide for 1 175 undergoing surgery with intraperitoneal chemotherapy and 1 127 undergoing surgery alone. Meta-analysis results showed that compared with surgery alone, surgery with intraperitoneal chemotherapy could improve the 1-year(OR=1.93,95 % CI 1.41-2.66,P<0.000 1),2-year(OR=1.82,95 % CI 1.41-2.35,P<0.000 01) and 3-year (OR= 1.93, 95 % CI 1.54 - 2.42, P< 0.000 01) survival rate of ACG cases, while the overall mortality was reduced (OR=0.47, 95 % CI 0.34-0.64, P<0.000 01). In terms of recurrence rate, the overall(OR=0.46,95 % CI 0.32-0.68,P<0.000 1)and peritoneal(OR=0.47,95 % CI 0.29-0.76,P=0.002) recurrence rates of surgery with intraperitoneal chemotherapy were both lower than those of surgery alone. There were not significantly differences between surgery with intraperitoneal chemotherapy and surgery alone in lymph nodes and liver metastasis rate. However, surgery with intraperitoneal chemotherapy had more high occurrence rates than surgery alone (OR= 1.47, 95 % CI 1.16 - 1.85, P= 0.001), especially the bone suppression (OR= 3.07, 95 % CI 1.70 - 5.54, P= 0.002) and bleeding (OR= 3.00, 95 % CI 1.09- 8.27, P= 0.03), and there were no differences in other complications. Subgroup results indicated that the overall mortalities were obviously decreased in surgery with intraperitoneal chemotherapy + MMC (OR= 0.35, 95 % CI 0.20-0.62,P=0.000 3)or CDDP+5-Fu(OR=0.32,95 % CI 0.17-0.61,P=0.000 5)compared with surgery alone. Conclusions Surgery with intraperitoneal chemotherapy can improve survival rate of AGC cases over a period of time and reduce mortality and peritoneal recurrence, but it is likely to cause the morbidities.The safety needs to be improved in the future.