针对局部晚期胃癌的多学科治疗:系统性审查和网络元分析
Zhiyuan Yu1, Huaiyu Tu2, Shuzhong Qiu3
1School of Medicine, Nankai University, Nankai District, Tianjin; Medical School of Chinese PLA; Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China.
Journal of minimal access surgery
|June 7, 2023
概括
高热性腹腔内化学疗法 (HIPEC) 与辅助化学疗法相结合,为局部晚期胃癌提供了最好的结果,减少了复发,转移和死亡率,而不会增加不良事件. 这种多学科的方法可以改善胃切除术后的生存率.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 局部晚期胃癌 (LAGC) 需要有效的多学科治疗策略.
- 激进胃切除术是主要的治疗方法,但辅助和新辅助疗法对于改善结果至关重要.
研究的目的:
- 评估各种多学科治疗对LAGC患者进行激进胃切除术的疗效.
- 为了比较单独的手术与不同辅助和新辅助治疗方案的有效性.
主要方法:
- 一个45个随机对照试验 (RCT) 的元分析,涉及10077名参与者.
- 搜索了RCT,比较单独的手术,辅助化疗 (CT),放射治疗 (RT),化学放射治疗 (CRT),新辅助CT,RT,CRT,外科CT和高热性腹腔内化疗 (HIPEC).
- 结果指标包括总生存率 (OS),无病生存率 (DFS),复发,转移,死亡率和不良事件.
主要成果:
- 与单独手术相比,辅助CT显著改善了OS和DFS.
- 与其他治疗相比,HIPEC+辅助CT显示复发率,转移率和死亡率较低.
- 在辅助治疗组之间没有观察到≥3级不良事件的显著差异.
- 新辅助疗法改善了R0切除率,但新辅助CT增加了手术并发症.
结论:
- 与辅助CT结合的HIPEC是LAGC最有效的辅助疗法,可以减少复发,转移和死亡率,而不会增加并发症.
- 与单独CT或RT相比,化疗放射治疗 (CRT) 可以减少复发,转移和死亡率,但会增加不良事件.
- 新辅助疗法提高了基因切除率,尽管新辅助CT可能会增加手术并发症.
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