Tan Hwee Leong, Chia Claramae Shulyn, Tan Grace Hwei Ching, Choo Su Pin, Tai David Wai-Meng, Chua Clarinda Wei Ling, Ng Matthew Chau Hsien, Soo Khee Chee, Teo Melissa Ching Ching
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
World J Gastrointest Oncol. 2017 Mar 15;9(3):121-128. doi: 10.4251/wjgo.v9.i3.121.
To characterize patients with gastric peritoneal carcinomatosis (PC) and their typical clinical and treatment course with palliative systemic chemotherapy as the current standard of care.
We performed a retrospective electronic chart review of all patients with gastric adenocarcinoma with PC diagnosed at initial metastatic presentation between January 2010 and December 2014 in a single tertiary referral centre.
We studied a total of 271 patients with a median age of 63.8 years and median follow-up duration of 5.1 mo. The majority ( = 217, 80.1%) had the peritoneum as the only site of metastasis at initial presentation. Palliative systemic chemotherapy was eventually planned for 175 (64.6%) of our patients at initial presentation, of which 171 were initiated on it. Choice of first-line regime was in accordance with the National Comprehensive Cancer Network Guidelines for Gastric Cancer Treatment. These patients underwent a median of one line of chemotherapy, completing a median of six cycles in total. Chemotherapy disruption due to unplanned hospitalizations occurred in 114 (66.7%), while cessation of chemotherapy occurred in 157 (91.8%), with 42 cessations primarily attributable to PC-related complications. Patients who had initiation of systemic chemotherapy had a significantly better median overall survival than those who did not (10.9 mo 1.6 mo, < 0.001). Of patients who had initiation of systemic chemotherapy, those who experienced any disruptions to chemotherapy due to unplanned hospitalizations had a significantly worse median overall survival compared to those who did not (8.7 mo 14.6 mo, < 0.001).
Gastric PC carries a grim prognosis with a clinical course fraught with disease-related complications which may attenuate any survival benefit which palliative systemic chemotherapy may have to offer. As such, investigational use of regional therapies is warranted and required validation in patients with isolated PC to maximize their survival outcomes in the long run.
对胃腹膜癌（PC）患者及其接受姑息性全身化疗作为当前标准治疗方案的典型临床和治疗过程进行特征描述。
我们对2010年1月至2014年12月期间在一家单一的三级转诊中心初次诊断为转移性胃腺癌伴PC的所有患者进行了回顾性电子病历审查。
我们共研究了271例患者，中位年龄为63.8岁，中位随访时间为5.1个月。大多数患者（n = 217，80.1%）在初次就诊时腹膜是唯一的转移部位。在初次就诊时，最终计划对175例（64.6%）患者进行姑息性全身化疗，其中171例开始接受化疗。一线治疗方案的选择符合美国国立综合癌症网络胃癌治疗指南。这些患者接受化疗的中位疗程为1个疗程，总共完成化疗的中位周期数为6个。114例（66.7%）患者因计划外住院导致化疗中断，157例（91.8%）患者化疗停止，其中42例停止主要归因于与PC相关的并发症。开始接受全身化疗的患者中位总生存期明显长于未接受化疗的患者（10.9个月对1.6个月，P < 0.001）。在开始接受全身化疗的患者中，因计划外住院导致化疗中断的患者中位总生存期明显短于未中断化疗的患者（8.7个月对14.6个月，P < 0.001）。
胃PC预后严峻，临床过程充满与疾病相关的并发症，这可能会削弱姑息性全身化疗可能带来的任何生存益处。因此，区域治疗的研究性应用是必要的，并且需要在孤立性PC患者中进行验证，以从长远来看最大化他们的生存结局。
