热灌注腹腔化疗（HIPEC）和新辅助化疗对晚期胃癌腹膜转移癌的预防作用——对总生存期和无病生存期的影响
Hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant chemotherapy as prophylaxis of peritoneal carcinosis from advanced gastric cancer-effects on overall and disease free survival.
作者信息
Coccolini Federico, Celotti Andrea, Ceresoli Marco, Montori Giulia, Marini Michele, Catena Fausto, Ansaloni Luca
机构信息
General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
General and Emergency surgery, Parma Maggiore Hospital, Parma, Italy.
出版信息
J Gastrointest Oncol. 2016 Aug;7(4):523-9. doi: 10.21037/jgo.2016.06.05.
BACKGROUND
The possibility to enlarge criteria for intra-peritoneal chemotherapy (IPC) to all patients at high-risk to develop peritoneal carcinosis (i.e., with serosal invasion) is still discussed.
METHODS
Retrospective case-control study. Three-groups: advanced-gastric-cancer (AGC) (pT4) without proven carcinosis: prophylactic group (PG), those with PC: treatment group (TG), AGC (pT3-pT4) operated without hyperthermic intraperitoneal chemotherapy (HIPEC), surgery alone group (SG T3, SG T4).
RESULTS
Forty four patients. 26 (59.1%) were male. Sixteen (36%) patients underwent 16 HIPEC: 6 (38%) had AGC (pT4) without PC (PG), 10 (62%) had carcinosis (TG), 28 were operated without HIPEC (SG T3, SG T4). The mean disease free survival (DFS): TG: 7.7 months, SG T4: 21.6 months, SG T3: 27.7 months, PG: 34.5 months. DFS was significantly different for TG (P=0.03, P=0.021, P=0.013 respectively). The mean OS TG: 10 months, SG T4: 27.1 months, SG T3: 28.2 months, PG: 34.6 months. OS was significantly different for TG (P=0.04, P=0.04, P=0.045 respectively). Severe complication rate: TG: 60%, PG: 16.7%, SG T3: 7.7% and SG T4: 25% (P=0.035). Length-of-stay differs significantly (P=0.003); overall length-of-stay: 19.41 days [standard deviation (SD) ±15.03]; TG: 33.01 (SD ±23.08), PG: 20.17 (SD ±6.21), SG T3: 11.33 (SD ±3.22), SG T4: 15.36 (SD ±5.48).
CONCLUSIONS
Prophylactic intraperitoneal chemotherapy associated to neoadjuvant chemotherapy increases the DFS and OS in patients with AGC without carcinosis. More data are needed in order to confirm these results.
背景
关于将腹腔内化疗（IPC）的标准扩大至所有有发生腹膜癌高风险（即有浆膜侵犯）患者的可能性仍在讨论中。
方法
回顾性病例对照研究。三组：无证实腹膜癌的进展期胃癌（AGC）（pT4）：预防组（PG）；有腹膜癌的患者：治疗组（TG）；未接受热灌注腹腔化疗（HIPEC）仅行手术的AGC（pT3 - pT4）患者，单纯手术组（SG T3、SG T4）。
结果
44例患者。26例（59.1%）为男性。16例（36%）患者接受了16次HIPEC：6例（38%）为无腹膜癌的AGC（pT4）（PG），10例（62%）有腹膜癌（TG），28例未接受HIPEC手术（SG T3、SG T4）。平均无病生存期（DFS）：TG组7.7个月，SG T4组21.6个月，SG T3组27.7个月，PG组34.5个月。TG组的DFS有显著差异（分别为P = 0.03、P = 0.021、P = 0.013）。平均总生存期（OS）：TG组10个月，SG T4组27.1个月，SG T3组28.2个月，PG组34.6个月。TG组的OS有显著差异（分别为P = 0.04、P = 0.04、P = 0.045）。严重并发症发生率：TG组60%，PG组16.7%，SG T3组7.7%，SG T4组25%（P = 0.035）。住院时间有显著差异（P = 0.003）；总体住院时间：19.41天[标准差（SD）±15.03]；TG组33.01（SD ±23.08），PG组20.17（SD ±6.21），SG T3组11.33（SD ±3.22），SG T4组15.36（SD ±5.48）。
结论
新辅助化疗联合预防性腹腔内化疗可提高无腹膜癌的AGC患者的DFS和OS。需要更多数据来证实这些结果。
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