Hyperthermic Intraperitoneal Chemotherapy Combined with Cytoreductive Surgery and Systemic Therapy Improves Prognosis in Colorectal Cancer with Peritoneal Metastases: An Updated Meta-Analysis.
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Abstract
Introduction: Patients with colorectal cancer (CRC) and peritoneal metastases (PMs) have a poor prognosis. The efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. This study aimed to evaluate the efficacy of HIPEC combined with cytoreductive surgery (CRS) and systemic therapy in these patients.
Methods: PubMed, Web of Science, Embase, and the Cochrane Library were searched from their inception to March 2026. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Treatment effects were quantified as pooled hazard ratios (HRs) with 95% confidence intervals (CIs).
Results: This meta-analysis included 12 studies (2 randomized controlled trials), 9 cohort studies, and 1 case-control study), encompassing >2,700 patients. Pooled analysis showed that the addition of HIPEC significantly improved OS (HR = 0.60, 95% CI: [0.51, 0.70], p < 0.001, I2 = 18.2%), with a 40% reduction in mortality, and significant PFS benefit (HR = 0.51, 95% CI: [0.30, 0.87], p = 0.013, I2 = 76.3%), with a 49% reduction in the risk of progression or death. Subgroup analyses demonstrated consistent OS benefits across regions (Eastern: HR = 0.50, 95% CI: [0.32, 0.78]; Western: HR = 0.62, 95% CI: [0.52, 0.74]) and follow-up durations (<30 months: HR = 0.57, 95% CI: [0.51, 0.63]; ≥30 months: HR = 0.60, 95% CI: [0.42, 0.85]). No significant OS benefit was observed in either the peritoneal cancer index (PCI) <11 (HR = 0.71, p = 0.089) or PCI ≥ 11 (HR = 0.53, p = 0.063) subgroups. Regarding PFS, a significant benefit was observed only in patients with PCI < 11 (HR = 0.74, p = 0.043), whereas no significant difference was found in those with PCI ≥ 11 (HR = 0.45, p = 0.066).
Conclusion: HIPEC combined with CRS and systemic therapy significantly improves prognosis in patients with CRC and PM.
期刊介绍：
Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.
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