PMID- 36969856
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230328
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 14
DP  - 2023
TI  - Survival and complications of cytoreductive surgery with hyperthermic 
      intraperitoneal chemotherapy in patients with intra-abdominal malignancies: A 
      meta-analysis of randomized controlled trials.
PG  - 1094834
LID - 10.3389/fphar.2023.1094834 [doi]
LID - 1094834
AB  - Background: Peritoneal metastasis (PM) is an advanced stage of intra-abdominal 
      malignancy with a very poor prognosis. In recent years, hyperthermic 
      intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) 
      has been utilized as an active treatment in the prevention and treatment of PM, 
      with encouraging results. However, compared with CRS alone, the results of the 
      CRS plus HIPEC strategy in the treatment of patients with intra-abdominal 
      malignancies are still controversial. This study sought to determine the impact 
      of HIPEC + CRS on patient survival and adverse events (AEs) by reviewing 
      randomized controlled trials (RCTs) for all types of intra-abdominal 
      malignancies. Methods: A PubMed, Embase, Cochrane Library, Web of Science and 
      Clinical Trials.gov search extracted all RCTs until 12 October 2022, examining 
      the CRS + HIPEC vs. CRS alone strategies in the treatment of various types of 
      intra-abdominal malignancies. The outcomes included overall survival (OS), 
      disease-free survival (DFS), relapse-free survival (RFS), progression-free 
      survival (PFS) and AEs. The dichotomous data were pooled and reported as odds 
      ratios (ORs) with 95% confidence intervals (CIs). The survival outcome data were 
      pooled using hazard ratios (HRs) and corresponding 95% CIs. The Cochrane 
      Collaboration's Risk of Bias Tool was used to assess the risk of bias in the 
      included studies. Results: A total of 12 RCTs were included in this 
      meta-analysis, including 873 patients in the CRS + HIPEC group and 878 patients 
      in the CRS alone group. The studies included 3 (617 patients) on colorectal 
      cancer, 4 (416 patients) on gastric cancer, and 5 (718 patients) on ovarian 
      cancer. Our analysis showed no difference in OS between the CRS + HIPEC and CRS 
      alone groups (HR: 0.79, 95% CI 0.62-1.01). Subgroup analysis showed that CRS + 
      HIPEC improved the OS of gastric cancer patients (HR: 0.49, 95% CI 0.32-0.76) 
      compared with CRS alone. However, CRS + HIPEC did not significantly improve the 
      OS of colorectal cancer (HR: 1.06, 95% CI 0.81-1.38) and ovarian cancer (HR: 
      0.82, 95% CI 0.62-1.07) patients. In addition, there was no significant 
      difference in DFS/RFS (HR: 0.78, 95% CI 0.57-1.07) or PFS (HR: 1.03, 95% CI 
      0.77-1.38) between the two groups. Compared with CRS alone, CRS with HIPEC had 
      greater nephrotoxicity (OR: 0.45, 95% CI 0.21-0.98), while other AEs did not 
      differ significantly between the two groups. Conclusion: Our results suggest that 
      CRS + HIPEC may improve OS in gastric cancer patients compared with CRS alone, 
      but we did not observe a benefit for DFS/RFS. For patients with ovarian and 
      colorectal cancers, our results suggest that HIPEC + CRS does not appear to 
      improve survival outcomes. In addition, CRS + HIPEC has higher nephrotoxicity 
      than CRS alone. More evidence from RCTs is needed to evaluate whether the use of 
      CRS + HIPEC is an appropriate option.
CI  - Copyright (c) 2023 Jian, Mou, Zhang, Fan and Ou.
FAU - Jian, Changchun
AU  - Jian C
AD  - Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
AD  - Orthopedic Laboratory of Chongqing Medical University, Chongqing, China.
FAU - Mou, Hai
AU  - Mou H
AD  - Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
AD  - Orthopedic Laboratory of Chongqing Medical University, Chongqing, China.
FAU - Zhang, Ye
AU  - Zhang Y
AD  - Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
AD  - Orthopedic Laboratory of Chongqing Medical University, Chongqing, China.
FAU - Fan, Qingxin
AU  - Fan Q
AD  - Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
AD  - Orthopedic Laboratory of Chongqing Medical University, Chongqing, China.
FAU - Ou, Yunsheng
AU  - Ou Y
AD  - Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
AD  - Orthopedic Laboratory of Chongqing Medical University, Chongqing, China.
LA  - eng
PT  - Journal Article
DEP - 20230309
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC10036049
OTO - NOTNLM
OT  - cytoreductive surgery
OT  - hyperthermic intraperitoneal chemotherapy
OT  - intra-abdominal malignancies
OT  - meta-analysis
OT  - peritoneal metastases
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/03/28 06:00
MHDA- 2023/03/28 06:01
PMCR- 2023/03/09
CRDT- 2023/03/27 03:43
PHST- 2022/11/10 00:00 [received]
PHST- 2023/02/27 00:00 [accepted]
PHST- 2023/03/27 03:43 [entrez]
PHST- 2023/03/28 06:00 [pubmed]
PHST- 2023/03/28 06:01 [medline]
PHST- 2023/03/09 00:00 [pmc-release]
AID - 1094834 [pii]
AID - 10.3389/fphar.2023.1094834 [doi]
PST - epublish
SO  - Front Pharmacol. 2023 Mar 9;14:1094834. doi: 10.3389/fphar.2023.1094834. 
      eCollection 2023.