Impact of preoperative chemotherapy on prognosis of pseudomyxoma peritonei treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy：a meta-analysis

doi:10.3877/cma.j.issn.1674-0785.2024.09.005

Abstract

Abstract:

Objective

To investigate the impact of preoperative chemotherapy on the prognosis of pseudomyxoma peritonei （PMP） treated by cytoreductive surgery （CRS） plus hyperthermic intraperitoneal chemotherapy （HIPEC）.

Methods

A literature search was conducted on cohort studies on the effects of preoperative chemotherapy on the prognosis of PMP from PubMed， Embase， Cochrane Library， CNKI，and Wanfang Database. The literature was screened according to the inclusion and exclusion criteria， and quality evaluation and data extraction were carried out. RevMan5.4 and Stata15.1 software were used for statistical analyses. The outcome indicators were overall survival （OS）， progression-free survival， and disease-free survival （DFS）.

Results

Seventeen articles were included in the meta-analysis. Fourteen articles reported the impact of preoperative chemotherapy on OS. The results of meta-analysis showed that the OS of the preoperative chemotherapy group was shorter than that of the non-preoperative chemotherapy group（hazard ratio ［HR］=1.58， P＜0.00001）. Stratified analysis showed that in patients with pathological types of high-grade tumors and high-grade tumors with signet ring cells， the OS of the preoperative chemotherapy group was shorter than that of the non-preoperative chemotherapy group （HR=1.62， P＜0.00001）. The OS of the preoperative chemotherapy group in Caucasian race was shorter than the non-chemotherapy group in Caucasian race （HR=1.65， P＜0.001）， but there was no statistically significant difference in the Asian race.Seven articles reported the impact of preoperative chemotherapy on PFS. The results showed that the PFS of the preoperative chemotherapy group was shorter than that of the non-chemotherapeutic group （HR=1.62，P＜0.001）. Stratified analysis showed that in patients with pathological types of high-grade tumors and highgrade tumors with signet ring cells， the PFS of the preoperative chemotherapy group was lower than that of the non-chemotherapeutic group， but the difference was not statistically significant （HR=1.24， P=0.31）. In both Asian and Caucasian races， the PFS of preoperative chemotherapy group was declined （HR=1.53 and 1.71，P=0.003 and 0.0002， respectively）. Sensitivity analysis and publication bias test both suggested stable results.

Conclusion

Preoperative chemotherapy has no OS and PFS benefit for PMP patients receiving CRS + HIPEC treatment. Because all the included studies are retrospective， and the possible important confounding factors such as baseline information， pathological types， and chemotherapy regimens had not been investigated in more detail， more stringent prospective studies are warranted for further verification.

Key words: Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Pseudomyxoma peritonei, Preoperative chemotherapy

Ying Zhang, Xin Zhao, Jiamei Chen, Yan Li. Impact of preoperative chemotherapy on prognosis of pseudomyxoma peritonei treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy：a meta-analysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(09): 826-835.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2024.09.005

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Figures/Tables 10

References 34

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作者	年份	国家	样本量（术前化疗，有/无）	中位年龄（范围）	术前化疗时间	病理类型	化疗方案	结局指标
Deraco	2006	意大利	20/55	57（24～76）	/	DPAM/PMCA	/	OS，PFS
Baratti	2009	意大利	22/80	53.5（24～76）	/	DPAM/PMCA	FOLFOX/FOLFIRI/5-FU/卡铂+紫杉醇/奥沙利铂+吉西他滨/其他含铂方案	OS，PFS
Vaira	2009	意大利	22/31	58（32～72）	/	阑尾腺癌	/	OS
Bijelic	2012	美国	34/24	50.7	6周期	PMCA	FOLFOX/XELOX贝伐单抗	OS
Turner	2013	美国	26/45	55（40～85）	3周期及以上	高级别阑尾腺癌	FOLFOX/FORFIRI/FOLFOX+贝伐单抗	OS
Kusamura	2013	意大利	37/119	53.5	/	DPAM/PMCA/PMCA-ID		PFS
Blackham	2014	美国	37/39	/	4（1.5～16）个月	高级别腹膜阑尾黏液癌	FOLFOX/FORFIRI/联合西妥昔单抗或贝伐单抗	OS，PFS
Milovanov	2015	美国	30/42	54（26～79）	3～8个周期	PMCA	FOLFOX/XELOX/FORFIRI	OS
Votanopoulos	2015	美国	/	53（20～87）	/	高级别阑尾癌腹膜转移	/	OS
Kusamura	2015	意大利	54/171	54.0±13.1	/	DPAM/PMCA/PMCA-ID	/	OS
Delhorme	2018	法国	107/198	/	/	低级别/高级别/未知PMP	/	OS，DFS
Munoz	2019	美国	74/77	/	/	HGCMP、HGCMP-S	/	PFS，OS
Masckauchan	2019	加拿大	/	52（33～70）	3～6个月	DPAM/PMCA/PMCA-I	5-FU为基础的方案	DFS
Sinukumar	2019	印度	31/60	53	/	低/高/高级别伴印戒细胞	/	PFS
Soucisse	2021	加拿大	43/160	/	/	DPAM/PMCA	/	OS
Garach	2021	印度	84/231	/	/	AnMN/AC/LG-AMN/HG-AMN/SRC AMN	/	OS，PFS
Zhang	2022	中国	55/39	54（24～76）	/	低/高/高级别伴印戒细胞	/	OS

作者	年份	国家	样本量（术前化疗，有/无）	中位年龄（范围）	术前化疗时间	病理类型	化疗方案	结局指标
Deraco	2006	意大利	20/55	57（24～76）	/	DPAM/PMCA	/	OS，PFS
Baratti	2009	意大利	22/80	53.5（24～76）	/	DPAM/PMCA	FOLFOX/FOLFIRI/5-FU/卡铂+紫杉醇/奥沙利铂+吉西他滨/其他含铂方案	OS，PFS
Vaira	2009	意大利	22/31	58（32～72）	/	阑尾腺癌	/	OS
Bijelic	2012	美国	34/24	50.7	6周期	PMCA	FOLFOX/XELOX贝伐单抗	OS
Turner	2013	美国	26/45	55（40～85）	3周期及以上	高级别阑尾腺癌	FOLFOX/FORFIRI/FOLFOX+贝伐单抗	OS
Kusamura	2013	意大利	37/119	53.5	/	DPAM/PMCA/PMCA-ID		PFS
Blackham	2014	美国	37/39	/	4（1.5～16）个月	高级别腹膜阑尾黏液癌	FOLFOX/FORFIRI/联合西妥昔单抗或贝伐单抗	OS，PFS
Milovanov	2015	美国	30/42	54（26～79）	3～8个周期	PMCA	FOLFOX/XELOX/FORFIRI	OS
Votanopoulos	2015	美国	/	53（20～87）	/	高级别阑尾癌腹膜转移	/	OS
Kusamura	2015	意大利	54/171	54.0±13.1	/	DPAM/PMCA/PMCA-ID	/	OS
Delhorme	2018	法国	107/198	/	/	低级别/高级别/未知PMP	/	OS，DFS
Munoz	2019	美国	74/77	/	/	HGCMP、HGCMP-S	/	PFS，OS
Masckauchan	2019	加拿大	/	52（33～70）	3～6个月	DPAM/PMCA/PMCA-I	5-FU为基础的方案	DFS
Sinukumar	2019	印度	31/60	53	/	低/高/高级别伴印戒细胞	/	PFS
Soucisse	2021	加拿大	43/160	/	/	DPAM/PMCA	/	OS
Garach	2021	印度	84/231	/	/	AnMN/AC/LG-AMN/HG-AMN/SRC AMN	/	OS，PFS
Zhang	2022	中国	55/39	54（24～76）	/	低/高/高级别伴印戒细胞	/	OS

作者	年份	病例选择				可比性	结局事件的评估	随访是否充分	随访完整性	评分
作者	年份	1	2	3	4	可比性	结局事件的评估	随访是否充分	随访完整性	评分
Deraco	2006	☆		☆	☆	☆	☆	☆	☆	7
Baratti	2009	☆		☆	☆	☆	☆	☆	☆	7
Vaira	2009	☆		☆	☆		☆	☆	☆	6
Bijelic	2012	☆	☆	☆	☆	☆	☆	☆	☆	8
Turner	2013	☆		☆	☆		☆	☆	☆	6
Kusamura	2013	☆		☆	☆	☆	☆	☆	☆	7
Blackham	2014	☆		☆	☆		☆	☆	☆	6
Milovanov	2015	☆		☆	☆	☆	☆	☆	☆	7
Votanopoulos	2015	☆		☆	☆	☆	☆	☆	☆	7
Kusamura	2015	☆		☆	☆	☆	☆	☆	☆	7
Delhorme	2018	☆		☆	☆	☆	☆	☆	☆	7
作者	年份	病例选择				可比性	结局事件的评估	随访是否充分	随访完整性	评分
作者	年份	1	2	3	4	可比性	结局事件的评估	随访是否充分	随访完整性	评分
Munoz	2019	☆		☆	☆	☆	☆	☆	☆	7
Masckauchan	2019	☆		☆	☆	☆	☆	☆	☆	7
Sinukumar	2019	☆		☆	☆	☆	☆	☆	☆	7
Soucisse	2021	☆		☆	☆		☆	☆	☆	6
Garach	2021	☆		☆	☆		☆	☆	☆	6
Zhang	2022	☆		☆	☆		☆	☆	☆	6

作者	年份	病例选择				可比性	结局事件的评估	随访是否充分	随访完整性	评分
作者	年份	1	2	3	4	可比性	结局事件的评估	随访是否充分	随访完整性	评分
Deraco	2006	☆		☆	☆	☆	☆	☆	☆	7
Baratti	2009	☆		☆	☆	☆	☆	☆	☆	7
Vaira	2009	☆		☆	☆		☆	☆	☆	6
Bijelic	2012	☆	☆	☆	☆	☆	☆	☆	☆	8
Turner	2013	☆		☆	☆		☆	☆	☆	6
Kusamura	2013	☆		☆	☆	☆	☆	☆	☆	7
Blackham	2014	☆		☆	☆		☆	☆	☆	6
Milovanov	2015	☆		☆	☆	☆	☆	☆	☆	7
Votanopoulos	2015	☆		☆	☆	☆	☆	☆	☆	7
Kusamura	2015	☆		☆	☆	☆	☆	☆	☆	7
Delhorme	2018	☆		☆	☆	☆	☆	☆	☆	7
作者	年份	病例选择				可比性	结局事件的评估	随访是否充分	随访完整性	评分
作者	年份	1	2	3	4	可比性	结局事件的评估	随访是否充分	随访完整性	评分
Munoz	2019	☆		☆	☆	☆	☆	☆	☆	7
Masckauchan	2019	☆		☆	☆	☆	☆	☆	☆	7
Sinukumar	2019	☆		☆	☆	☆	☆	☆	☆	7
Soucisse	2021	☆		☆	☆		☆	☆	☆	6
Garach	2021	☆		☆	☆		☆	☆	☆	6
Zhang	2022	☆		☆	☆		☆	☆	☆	6

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