A Meta Analysis Of Hyperthermic Intraperitoneal Perfusion Chemotherapy Combined With Intravenous Chemotherapy For Gastrointestinal Cancer After Radical Resection

Background: Gastrointestinal cancer ranks the top five cancers in the world and the most effective treatment is surgery.However,patients with gastrointestinal cancer still face a high risk of local recurrence and distant metastasis after radical surgery.Many studies shows that hyperthermic intraperitoneal chemotherapy combined with intravenous Perfusion chemotherapy(HIPC+IC)could reduce the rate of recurrence and metastasis and improve the prognosis of gastrointestinal cancer after radical resection.Therefore,studing the efficacy and safety of HIPC+IC has greatly scientific significance for gastrointestinal cancer after radical resection.Objective: To evaluate the efficacy and safety of HIPC+IC for gastrointestinal cancer after radical resection.Methods: The relevant studies from domestic and foreign databases of Web of Science,PubMed,the Cochrane Library,EMBASE,CBM,CNKI,WanFang and VIP databases were comprehensively retrieved to collect all relevant randomized controlled trials(RCTs)of HIPC+IC and IC for the treatment of gastrointestinal cancer after radical resection.Two reviewers independently used EndNote X9 to screen,remove,and include documents and Excel to extract data.The included studies were evaluated and analyzed by the Cochrane Systematic Review Manual’criteria and RevMan 5.3 software.Results: 45 RCTs were included,involving 4423 patients.Meta-analysis: 1.Efficacy: Compared with IC group,the HIPC+IC group was higher in 1-year survival rate,2-year survival rate,3-year survival rate and 5-year survival rate,and the OR and95% CI were(2.25,1.70~2.97),(2.55,1.89~3.43),(2.46,2.14~2.82)and(2.53,2.07 ~ 3.08),respectively,and there were significant differences(P<0.00001).Simultaneously,there was significant different(P<0.05)between the two groups in recurrence rate,Peritoneal metastasis rate,distant metastasis rate and liver metastasis,and the HIPC group were lower than the IC group,and the OR and 95% CI were(0.34,0.27~0.42),(0.35,0.20~0.35),(0.45,0.33~0.62)and(0.39,0.27~0.57),respectively.2.Safety:Compared with IC group,the HIPC+IC group was lower in the incidence of nausea and vomiting,leukopenia,neurotoxicity,thrombocytopenia,Ⅲ-Ⅳ degree thrombocytopenia and Ⅲ-Ⅳ degree nausea and vomiting,and the HIPC+IC group was higher in the incidence of liver dysfunction,renal dysfunction,intestinal obstruction,diarrhea,abdominal pain and bloating,III-IV leukopenia andⅢ-IV liver dysfunction.However,only the incidence of abdominal pain and distension and leukopenia had significant differences(P<0.05).3.Compared with IC group,the HIPC+IC group was lower in the levels of CEA and CA199 in the blood,and the MD and 95% CI were(-5.52,-12.52 ~ 2.02)and(-16.37,-23.44 ~-9.3),respectively,only the tumor marker CA199 had significant differences(P<0.05)(P<0.05).Conclusion: Compared with IC,the HIPC+IC had better respectable efficacy,lower level of CA199 and feasible safety for the treatment of gastrointestinal after radical resection.