Fugazzola Paola, Coccolini Federico, Montori Giulia, Ceresoli Marco, Baggi Paolo, Costanzo Antonio, Tomasoni Matteo, Gregis Francesco, Nozza Silvia, Ansaloni Luca
Department of General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
Department of Farmacology, ASST Papa Giovanni XXIII, Bergamo, Italy.
J Gastrointest Oncol. 2017 Jun;8(3):572-582. doi: 10.21037/jgo.2017.03.11.
Our experience regarding cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was reviewed in terms of overall survival (OS) and disease-free survival (DFS) in patients with synchronous peritoneal carcinomatosis (SPC) and metachronous peritoneal carcinomatosis (MPC) from gastric cancer (GC).
An analysis of prospectively collected data about patients who underwent CRS and HIPEC from July 2011 to July 2016 was carried out. Patients and tumor characteristics were taken into consideration together with pre and post-operative data. The outcomes concerned OS and DFS in both groups.
A total of 17 cases were reported. All patients of SPC group underwent neoadjuvant chemotherapy, while all patients of MPC group underwent adjuvant chemotherapy subsequently to surgery of the primary tumor. The mean follow up period was 9 months (SD±9.5). Thirteen patients (76.5%) had SPC and four (23.5%) had MPC. The mean total Peritoneal Cancer Index (PCI) was 8.5 (SD±8.4). The mean PCI was 3.75 (SD±4.9) for SPC group and 16 (SD±9.5) for MPC (P=0.003). HIPEC regimen was cisplatin plus paclitaxel for fourteen patients (82.4%) and cisplatin plus mitomycin-C (MMC) for three patients (17.6%). OS was 16 months and 6 months respectively in patients with SPC and MPC (P=0.189). DFS was 11 months and 2 months respectively in the two groups (P=0.156). Patients with SPC patients and PCI ≥12 were significantly different in terms of DFS from SPC with PCI <12 (P=0.001). Overall, twelve patients had postoperative major complications (CTCAE>2), in particular eight (61%) in SPC group while four (100%) in MPC group. Our study showed significantly better DFS for patients aged >60 years (P=0.016).
HIPEC and CRS with cisplatin and paclitaxel in patients with PC from GC showed promising results in improving the DFS and the OS, particularly for patients with PCI <12 and for those aged >60. Although a high incidence of complications was revealed, especially in MPC group.
我们回顾了关于胃癌（GC）同步性腹膜癌病（SPC）和异时性腹膜癌病（MPC）患者接受细胞减灭术（CRS）和热灌注化疗（HIPEC）后的总生存期（OS）和无病生存期（DFS）的经验。
对2011年7月至2016年7月期间接受CRS和HIPEC的患者的前瞻性收集数据进行分析。考虑了患者和肿瘤特征以及术前和术后数据。关注两组的OS和DFS结果。
共报告17例病例。SPC组所有患者均接受新辅助化疗，而MPC组所有患者在原发性肿瘤手术后均接受辅助化疗。平均随访期为9个月（标准差±9.5）。13例患者（76.5%）患有SPC，4例（23.5%）患有MPC。平均总腹膜癌指数（PCI）为8.5（标准差±8.4）。SPC组平均PCI为3.75（标准差±4.9），MPC组为16（标准差±9.5）（P = 0.003）。14例患者（82.4%）的HIPEC方案为顺铂加紫杉醇，3例患者（17.6%）为顺铂加丝裂霉素-C（MMC）。SPC和MPC患者的OS分别为16个月和6个月（P = 0.189）。两组的DFS分别为11个月和2个月（P = 0.156）。SPC且PCI≥12的患者与PCI<12的SPC患者在DFS方面有显著差异（P = 0.001）。总体而言，12例患者有术后严重并发症（CTCAE>2），特别是SPC组8例（61%），MPC组4例（100%）。我们的研究显示年龄>60岁的患者DFS明显更好（P = 0.016）。
GC来源的PC患者接受含顺铂和紫杉醇的HIPEC和CRS在改善DFS和OS方面显示出有前景的结果，特别是对于PCI<12的患者和年龄>60岁的患者。尽管并发症发生率较高，尤其是在MPC组。
