胃癌的腹腔内化学疗法用于胃癌
Mingchun Mu1,2,3, Zhaolun Cai1,2,3, Yajun Hu4
1Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
胃癌的肠膜内化疗 (IPC) 显示出潜在的生存益处,但由于结果的确定性较低,缺乏明确的证据. 需要进一步进行高质量的试验,以确认预防和治疗腹转移的疗效和安全性.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 临床试验 临床试验
- 化疗 化疗是一种化学疗法.
背景情况:
- 腹膜转移的胃癌的预后不好,通常被认为是无法治愈的.
- 腹膜内化学疗法 (IPC) 正在探索用于预防和治疗腹膜转移,但临床证据是相互矛盾的.
- 需要对IPC对胃癌的影响进行全面评估.
研究的目的:
- 评估IPC在胃癌中的益处和危害.
- 具体来说,为了比较高风险患者的预防性IPC加急性手术与单独的急性手术.
- 此外,还要比较治疗性IPC加上细胞还原手术 (CRS) 与单独CRS,对于确诊腹膜转移的患者.
主要方法:
- 对多个数据库 (CENTRAL,MEDLINE,Embase,中国数据库) 和试验注册表进行了系统的搜索.
- 包括并行随机对照试验 (RCT),比较IPC与没有IPC的预防或治疗用途.
- 用元分析来综合总体存活率,无病存活率 (DFS),无进展存活率 (PFS) 和不良事件的结果,通过GRADE评估证据确定性.
主要成果:
- 包括9个涉及829名参与者的RCT;大多数有偏见或一些担忧的高风险.
- 非常低的确定性证据表明,预防性和治疗性IPC可能会改善整体存活率,但可能对DFS或静脉漏的影响很小.
- 治疗性IPC可能会延迟瘤进展 (PFS),但在生活质量 (QOL) 或严重不良事件 (SAE) 中几乎没有差异.
结论:
- 目前IPC在胃癌中的证据有限且高度不确定,排除了最终的结论.
- IPC可能有助于生存,但需要更多高质量的长期RCT,特别是非亚洲人群.
- 目前正在进行的研究可能会改变当前的研究结果;也需要全面的安全性和质量生活数据.
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