Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2020 Dec;27(13):4963-4969. doi: 10.1245/s10434-020-08842-7. Epub 2020 Jul 9.
Although laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) has been proven safe in patients with gastric adenocarcinoma and carcinomatosis or positive cytology, patient selection criteria remain unclear. Thus, we perform a retrospective analysis to identify factors associated with improved survival and resection rates.
Data for all patients undergoing LS-HIPEC for stage IV gastric adenocarcinoma between June 2014 and November 2018 were collected prospectively and analyzed for associations with survival and resection using uni- and multivariate logistic regression, Cox proportional hazards models, and Kaplan-Meier survival functions.
Of 70 patients who underwent LS-HIPEC, 43 (61%) received two drugs (mitomycin C and cisplatin), and 27 (39%) received three drugs (mitomycin C, cisplatin, and paclitaxel). The two groups' demographic and oncologic differences were not significant, although the three-drug group had a significantly lower rate of radiation therapy use (58% vs. 15%; p < 0.01). Univariate analysis revealed that poor differentiation [Cox hazard ratio (HR) 2.75; 95% confidence interval (CI) 1.34-5.63; p < 0.01], gross carcinomatosis (HR 3.10; 95% CI 1.52-6.30; p = 0.03), and ascites (HR 3.43; 95% CI 1.88-6.26; p < 0.01) were associated with shorter median survival. Gastrectomy was associated with improved overall survival (HR 0.32; 95% CI 0.15-0.70; p < 0.01). The resection rate of the 45 patients without ascites (38%) was significantly higher than that of the 25 patients with ascites (0%; p < 0.01).
Our findings identify ascites as a significant prognostic factor for gastric cancer patients with peritoneal metastases undergoing LS-HIPEC. Our findings can be used to help identify patients who are unlikely to proceed to resection after LS-HIPEC and are good candidates for novel therapeutic approaches or clinical trials.
尽管腹腔镜腹腔内热灌注化疗（LS-HIPEC）已被证明在胃腺癌和癌性腹水或细胞学阳性患者中是安全的，但患者选择标准仍不清楚。因此，我们进行了一项回顾性分析，以确定与生存率和切除率提高相关的因素。
前瞻性收集 2014 年 6 月至 2018 年 11 月期间接受 LS-HIPEC 治疗的所有 IV 期胃腺癌患者的数据，并使用单变量和多变量逻辑回归、Cox 比例风险模型和 Kaplan-Meier 生存函数分析与生存和切除相关的因素。
在接受 LS-HIPEC 的 70 例患者中，43 例（61%）接受了两种药物（丝裂霉素 C 和顺铂），27 例（39%）接受了三种药物（丝裂霉素 C、顺铂和紫杉醇）。两组的人口统计学和肿瘤学差异无显著性，但三组的放疗使用率明显较低（58%对 15%；p<0.01）。单因素分析显示，低分化[Cox 风险比（HR）2.75；95%置信区间（CI）1.34-5.63；p<0.01]、大体癌性腹水（HR 3.10；95%CI 1.52-6.30；p=0.03）和腹水（HR 3.43；95%CI 1.88-6.26；p<0.01）与中位生存期较短相关。胃切除术与总生存率提高相关（HR 0.32；95%CI 0.15-0.70；p<0.01）。无腹水的 45 例患者（38%）的切除率明显高于有腹水的 25 例患者（0%；p<0.01）。
我们的研究结果确定腹水是接受 LS-HIPEC 的腹膜转移胃腺癌患者的一个显著预后因素。我们的研究结果可以帮助确定 LS-HIPEC 后不太可能进行切除的患者，并为新的治疗方法或临床试验提供良好的候选者。
