腹腔转移高风险结肠癌患者的辅助热腹腔化疗:个体患者数据荟萃分析

IF 8.6 1区 医学 Q1 SURGERY
Julie J M Hamm, Rudolf van den Berg, Eleni-Rosalina Andrinopoulou, E Sophie Zwanenburg, Gijsbert D Musters, Pieter J Tanis, Alvaro Arjona-Sanchez
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引用次数: 0

摘要

背景:大约四分之一的局部晚期结肠癌(pT4)患者发生局部复发,包括腹膜转移。本个体患者数据荟萃分析(IPDMA)的目的是评估辅助热腹腔化疗(HIPEC)在降低整体人群和局部晚期结肠癌患者高危亚组的局部区域复发率方面的疗效。方法:于2024年7月进行系统文献检索,确定局部晚期结肠癌在常规辅助全身化疗的基础上进行辅助HIPEC的rct。IPDMA以局部复发率为主要终点,无病生存期(DFS)和总生存期(OS)为次要终点。结果:检索确定了两个试验(COLOPEC和HIPECT4)。我们收集了386例患者的个人资料,其中189例患者接受了辅助HIPEC治疗,197例患者为对照组。中位随访为36个月(四分位数间距32-60)。一项改进的意向治疗分析显示,HIPEC患者36个月的局部复发率为16.0%,对照组为21.2% (P = 0.295)。预先设定的亚组分析显示右侧肿瘤患者HIPEC术后局部复发显著降低(HR 0.56 (95% ci 0.48 ~ 0.67)) (P < 0.001)。在整个研究人群中,生存率没有发现显著差异;亚组的低事件发生率不允许进行生存分析。结论:辅助HIPEC显著降低了右侧局部晚期结肠癌的局部复发率,但在整个研究人群中没有。关于DFS和OS的明确结论需要更长的随访时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adjuvant hyperthermic intraperitoneal chemotherapy in patients with colon cancer at high risk of peritoneal metastases: individual patient data meta-analysis.

Background: About a quarter of patients with locally advanced colon cancer (pT4) develop locoregional recurrence, including peritoneal metastases. The aim of this individual patient data meta-analysis (IPDMA) was to evaluate the efficacy of adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) with regard to reducing the locoregional recurrence rate in the overall population and high-risk subgroups of patients with locally advanced colon cancer.

Methods: A systematic literature search was conducted in July 2024 to identify RCTs on adjuvant HIPEC in addition to routine adjuvant systemic chemotherapy in locally advanced colon carcinoma. An IPDMA was performed, with the locoregional recurrence rate as the primary endpoint and disease-free survival (DFS) and overall survival (OS) as secondary endpoints.

Results: The search identified two trials (COLOPEC and HIPECT4). Individual patient data were pooled for 386 patients, of whom 189 patients received adjuvant HIPEC and 197 patients constituted the control group. The median follow-up was 36 (interquartile range 32-60) months. A modified intention-to-treat analysis showed a 36-month locoregional recurrence rate of 16.0% for HIPEC patients and 21.2% for control patients (P = 0.295). Predefined subgroup analyses revealed a significant reduction in locoregional recurrence after HIPEC in patients with right-sided tumours (HR 0.56 (95% c.i. 0.48 to 0.67)) (P < 0.001). No significant differences in survival were found for the overall study population; low event rates in subgroups did not allow for survival analyses.

Conclusion: Adjuvant HIPEC significantly reduced the locoregional recurrence rate in right-sided locally advanced colon cancer, but not in the overall study population. Definitive conclusions on DFS and OS require longer follow-up.

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来源期刊
CiteScore
12.70
自引率
7.30%
发文量
1102
审稿时长
1.5 months
期刊介绍: The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.
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