Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Medical Clinic for Hematology, Oncology and Tumor-Immunology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Gastric Cancer. 2019 Nov;22(6):1226-1237. doi: 10.1007/s10120-019-00969-1. Epub 2019 May 7.
Patients with peritoneal metastases of gastric cancer have a poor prognosis and median survival of 7 months. This study compared treatment options and outcomes based on the Peritoneal Cancer Index (PCI).
This retrospective analysis included patients with gastric cancer treated between August 2008 and December 2017 with synchronous peritoneal metastases only diagnosed by laparoscopy. The three treatments were as follows: (1) cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with pre- and postoperative systemic chemotherapy (n = 58), (2) laparotomy/laparoscopy without CRS, but HIPEC in combination with pre- and postoperative systemic chemotherapy (n = 11), and (3) systemic chemotherapy only (n = 19).
A total of 88 patients aged 54.6 ± 10.9 years with mean PCI of 14.3 ± 11.3 were included. The PCI was significantly lower in group 1 (8.3 ± 5.7) than in group 2 (23.9 ± 11.1, p < 0.001) and group 3 (27.3 ± 9.3, p < 0.001). Mean time from diagnosis to laparoscopy was 5.2 ± 2.9 months. The median overall survival was 9.8 ± 0.7 for group 1, 6.3 ± 3.0 for group 2 and 4.9 ± 1.9 months for group 3 (p < 0.001). Predictors for deteriorated overall patient survival included > 4 cycles of preoperative chemotherapy (HR 4.49, p < 0.001), lymph-node metastasis (HR 3.53, p = 0.005), PCI ≥ 12 (HR 2.11, p = 0.036), and incompleteness of cytoreduction (HR 4.30, p = 0.001) in patients treated with CRS and HIPEC.
CRS and HIPEC showed convincing results in selected patients with PCI < 12 and complete cytoreduction. Prolonged duration (> 4 cycles) of preoperative intravenous chemotherapy reduced patient survival in patients suitable for CRS and HIPEC.
患有胃癌腹膜转移的患者预后较差，中位生存期为 7 个月。本研究基于腹膜肿瘤指数（PCI）比较了不同治疗方案的疗效和预后。
本回顾性分析纳入了 2008 年 8 月至 2017 年 12 月期间仅通过腹腔镜诊断为同步腹膜转移的胃癌患者。三种治疗方法如下：（1）细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）联合术前和术后全身化疗（n=58）；（2）剖腹术/腹腔镜手术不进行 CRS，但进行 HIPEC 联合术前和术后全身化疗（n=11）；（3）单纯全身化疗（n=19）。
共纳入 88 例年龄 54.6±10.9 岁的患者，平均 PCI 为 14.3±11.3。与组 2（23.9±11.1，p<0.001）和组 3（27.3±9.3，p<0.001）相比，组 1 的 PCI 显著较低（8.3±5.7）。从诊断到腹腔镜检查的平均时间为 5.2±2.9 个月。组 1、组 2 和组 3 的中位总生存期分别为 9.8±0.7 个月、6.3±3.0 个月和 4.9±1.9 个月（p<0.001）。总体患者生存恶化的预测因素包括术前化疗周期数>4 个（HR 4.49，p<0.001）、淋巴结转移（HR 3.53，p=0.005）、PCI≥12（HR 2.11，p=0.036）和 CRS+HIPEC 治疗不完全减瘤（HR 4.30，p=0.001）。
在 PCI<12 和完全减瘤的患者中，CRS 和 HIPEC 显示出令人信服的结果。适合 CRS+HIPEC 的患者，术前静脉化疗时间延长（>4 个周期）会降低患者的生存。
