Objective To systematically review the effectiveness and safety of hyperthermia (HT) plus intraperitoneal hyperthermic perfusion chemotherapy (IHPC) versus IHPC alone for malignant ascites. Methods Such databases as PubMed, The Cochrane Library, EMbase, VIP, WanFang, CNKI and CBM were electronically and comprehensively searched for randomized controlled trials (RCTs) on HT plus IHPC vs. IHPC alone for malignant ascites from inception to March 2013. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data and assessed quality of the included studies. References of the included studies were also retrieved. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 16 RCTs involving 984 patients were included. The results of meta-analysis showed that, compared with the IHPC alone group, the HT plus IHPC group had a higher effective rate of controlling ascites (OR=3.40, 95%CI 2.58 to 4.48, Plt;0.000 01), better improvement in quality of life (OR=2.77, 95%CI 1.90 to 4.05, Plt;0.000 01), with significant differences. The two groups were alike in 1-year survival with no significant difference (OR=1.80, 95%CI 0.61 to 5.31, P=0.28). As for safety, there was no significant difference between the two groups in the incidences of nausea and vomiting, abdominal distension and pain, myelosuppression, diarrhea, and constipation. Conclusion The results of this systematic review show that, compared with IHPC alone, HT plus IHPC improves the effective rate as well as the quality of life of patients with malignant ascites, and it does not increase the incidences of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality RCTs with larger sample size are needed to verify the above conclusion.
Objective To establish the overall diagnostic accuracy of the measurements of vascular endothelial growth factor (VEGF) for malignant ascites. Methods After a systematic review of current studies, sensitivity, specificity, and other measures of the value of ascites concentrations of VEGF in the diagnosis of malignant ascites were pooled by using random effects models. Qualified studies on evaluation of VEGF in diagnosis of malignant ascites in English and Chinese published from January 1990 to December 2009 were retrieved from The Cochrane Library, Cochrane Central Register of Controlled Trials, MEDLINE, EMbase, China National Knowledge Infrastructure (CNKI) databases, WanFang Data, and VIP Information. Two reviewers independently assessed the methodological quality of each study with the tool of QUADAS. Statistical analyses were performed by employing Meta-Disc 1.4 software. Meta-analyses of the reported sensitivity and specificity of each study and Summary Receiver Operating Characteristic (SROC) curve were performed. Results Seven studies met the inclusion criteria for the analysis. After testing the heterogeneity of the included studies, a random effect model was selected to calculate the pool weighted sensitivity and specificity with 95% confidence interval: the sensitivity was 0.81 (95%CI 0.75 to 0.85), the specificity was 0.90 (95%CI 0.86 to 0.94), the DOR was 50.45 (95%CI 28.37 to 89.73), and the AUC of SROC was 0.9507 (SE=0.013 0). The subgroups were analyzed to identify the sources of heterogeneity according to race and agent sources. There was homogeneity among the three studies with agents from Ramp;D company (χ2=0.05, P=0.9750; I2=0.0%), and the AUC of SROC were 0.9675 (SE=0.016 7). Conclusion VEGF has a highly accurate sensitivity and specificity with a b ROC curve, which makes it a new marker to differentiate malignant ascites from the benign.