Cancer Res Treat. 2003 Dec;35(6):507-13. doi: 10.4143/crt.2003.35.6.507.
Peritoneal seeding is the most common type of metastasis or recurrence and one of the poor prognostic factors in gastric cancer. Moreover, there are as yet no effective treatment modalities available. Recently some research groups suggested the benefit of combined cytoreductive surgery and intraperitoneal chemotherapy, but the related experiments remain in the trial stage. Therefore, we assessed the safety and evaluated the efficacy of combined cytoreductive surgery and early postoperative intraperitoneal chemotherapy (EPIC) in gastric cancer patients with peritoneal carcinomatosis of gastric cancer.
From Nov. 1997 to May. 2002, eighteen cases of combined cytoreduction and EPIC were performed in the Korea Cancer Center Hospital due to gastric cancer with peritoneal carcinomatosis. The control group consisted of 33 patients who had no resection without EPIC during the same periods. After combined cytoreductive surgery and EPIC, all patients received systemic chemotheraphy with the exception of 2 patients who could not tolerate the treatment. We retrospectively investigated the clinicopathologic features and analyzed the factors affecting the prognosis. Median follow-up period was 11.9 months (range 0.5~61 months). Statistical analysis was performed by SPSS 11.0 for Windows. A P-value less than 0.05 was considered as statistically significant.
There was one case of the treatment-related mortality (5.5%) and seven cases of treatment-related complications (38%) in the combined cytoreductive surgery and intraperitoneal chemotherapy group. One-, 3- and 5-year survival rates of cytoreductive surgery plus EPIC were 57.6%, 25.9% and 13.0%, respectively, and those of the control group were 18.2%, 3% and 0%, respectively. Survival of the combined cytoreductive surgery plus EPIC group was better than that of the control group (p=0.0026). In multivariate analysis of prognostic factors affecting the survival, combined cytoreductive surgery plus EPIC (p=0.02) and systemic chemotherapy (p=0.019) were independent prognostic factors.
Although a small number of cases were included in this study, combined cytoreductive surgery plus EPIC showed survival benefit and retained a comparable complication rate compared with the control group.
腹膜播种是胃癌最常见的转移或复发类型，也是预后不良的因素之一。此外，目前尚无有效的治疗方法。最近，一些研究小组提出了联合细胞减灭术和腹腔内化疗的益处，但相关实验仍处于试验阶段。因此，我们评估了联合细胞减灭术和早期术后腹腔内化疗（EPIC）在胃癌伴腹膜转移患者中的安全性，并评估了其疗效。
从 1997 年 11 月至 2002 年 5 月，韩国癌症中心医院对 18 例胃癌伴腹膜转移的患者进行了联合细胞减灭术和 EPIC 治疗。对照组由 33 例同期未行 EPIC 切除术的患者组成。在联合细胞减灭术和 EPIC 后，所有患者均接受全身化疗，但有 2 例患者因无法耐受治疗而未接受。我们回顾性地调查了临床病理特征，并分析了影响预后的因素。中位随访时间为 11.9 个月（0.5~61 个月）。采用 SPSS 11.0 for Windows 进行统计学分析。P 值小于 0.05 被认为具有统计学意义。
联合细胞减灭术和腹腔内化疗组有 1 例与治疗相关的死亡（5.5%）和 7 例与治疗相关的并发症（38%）。联合细胞减灭术加 EPIC 的 1、3、5 年生存率分别为 57.6%、25.9%和 13.0%，对照组分别为 18.2%、3%和 0%。联合细胞减灭术加 EPIC 组的生存率优于对照组（p=0.0026）。在影响生存的预后因素的多因素分析中，联合细胞减灭术加 EPIC（p=0.02）和全身化疗（p=0.019）是独立的预后因素。
尽管本研究纳入的病例数较少，但与对照组相比，联合细胞减灭术加 EPIC 显示出生存获益，并保持了相当的并发症发生率。
