Meta Analysis Of Advanced Ovarian Cancer On Tumor Cell Depletion Combined With Intraperitoneal Hyperthermic Chemotherapy

Objective:To investigate the therapeutic effect of tumor cell reduction combined with intraperitoneal hyperperfusion chemotherapy and tumor cell reduction without intraperitoneal hyperperfusion chemotherapy on advanced ovarian cancer.Methods:1.Formulate retrieval strategies and conduct computer retrieval of databases such as PubMed,Cochrane library,Embase,Google academic,cnki,wanfang,viper,and Chinese medical literature database.2.Determine the inclusion criteria,and conduct literature screening with Endnoter software.The literature screening,the later quality assessment and the extraction of relevant data are all completed by two people independently.3.Risk assessment of included randomized controlled clinical studies and case-control studies was conducted using the Cochrane risk bias assessment software and the newcastle-ottawa scale,respectively.Revmen 5.3 software was used for statistical analysis.If the study was homogeneous,the fixed effect model was used;otherwise,the random effect model was used for combination.Studies with heterogeneity were first analyzed by subgroup analysis and sensitivity analysis,and the sources of heterogeneity were analyzed.If the heterogeneity principle could not be explained,the analysis results were considered to be abandoned.4.The evaluation indexes of this study included: overall survival rate,progression-free survival rate,annual survival rate,recurrence rate,incidence of grade 3⁴ adverse events,and short-term effective rate,etc.Results:A total of 19 articles were included,including 3 randomized controlled trials and 16 retrospective studies,including 6 in Chinese and 13 in English^[1-19].There were 1640 patients,including 789 patients in the group of tumor cell reduction combined with systemic intravenous chemotherapy and intraperitoneal hyperthermia chemotherapy group（group H for short）.There were 851 cases in the group of tumor cell reduction plus systemic intravenous chemotherapy without peritoneal hyperthermic chemotherapy（non-h group for short）.Comprehensive analysis of the results showed:（1）a total of 9 article reported combined abdominal hot perfusion chemotherapy information about the end of the 5-year survival rate,in which H group of 350 patients,434 patients of group H,data results show that the joint abdominal tumor cells to destroy the loss hot perfusion chemotherapy（group H）a simple line of tumor cell group（group H）to cut loss,joint abdominal cavity perfusion chemotherapy can effectively prolong the lifetime hot;（2）a total of four articles reported information on progression-free surial outcome,among them,the group H 301 patients,263 patients of group H,the analysis results show that H group than in group H progression-free surial 3 years significantly extended,joint abdominal hot perfusion chemotherapy can significantly reduce the recurrence of the malignant tumor,improve the disease-free survival of patients;（3）a total of 12 articles reported the outcomes of disease recurrence in the treatment of ovarian cancer in the H group and the non-h group,including 510 patients in the H group and 493 patients in the non-h group.The data results indicated that the difference in recurrence rate between group H and non-group H was statistically significant,and the overall recurrence rate of group H,especially the peritoneal recurrence rate,was significantly lower than that of non-group H.（4）a total of 7 studies reported the occurrence data of grade 3⁴ adverse events in the treatment of ovarian cancer patients,including 330 patients in the H group and 432 patients in the non-h group.The data showed that the incidence of serious adverse events in combination with intraperitoneal hyperperfusion chemotherapy was higher than that in the control group（23.6% and 17.2%,respectively）.（5）5 articles reported the short-term effective rate of treatment of ovarian malignancy in group H and non-h groups,with the short-term effective rate of 67.5% in group H and 41.1% in non-h group.The difference of short-term efficiency between group H and non-group H was statistically significant.Conclusions:1.In the treatment of primary or recurrent advanced ovarian cancer,compared with tumor cytoreductive surgery combined with systemic intravenous combined chemotherapy,intraoperative and postoperative combined intraperitoneal hyperthermic chemotherapy can significantly prolong the progression-free survival of patients and increase Annual survival rate,reduce the recurrence rate,while improving the near-term efficiency.2.In the treatment of primary or recurrent advanced ovarian cancer,intraoperative and postoperative chemotherapy combined with intraperitoneal hyperthermic chemotherapy is more likely to increase the incidence of grade 3⁴ adverse reactions compared with tumor cell reduction combined with systemic intravenous chemotherapy.Therefore,before the implementation,the patient’s physical condition needs to be included in the evaluation range,and after comprehensive evaluation,it is decided whether to use intraperitoneal hyperthermic chemotherapy.3.Standardized application is the basis to ensure the safety of HIPEC.Conduct multiple single-center collaborative research and providing high-quality evidence-based medical evidence is the fundamental way to further clarify the efficacy of HIPEC and solve clinically related problems.