Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany; Digestive Unit, Champalimaud Foundation, Lisbon, Portugal.
Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Eur J Surg Oncol. 2021 Jan;47(1):172-180. doi: 10.1016/j.ejso.2020.10.006. Epub 2020 Oct 14.
Peritoneal metastasis (PM) of gastric cancer (GC) is relatively common (17%) and is associated with poor survival. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is still controversially discussed, as it has proven an increase in survival in selected patients, but only a small subgroup reached long-term survival. The aim of this study was to collect and analyse a worldwide cohort of patients treated with CRS and HIPEC with long-term survival in order to explore relevant patient characteristics.
We conducted a questionnaire, which was distributed to all collaborators of the Peritoneal Surface Oncology Group International (PSOGI). Inclusion criteria were: histopathologic proven PM of GC, treated with CRS and HIPEC, and overall survival >5 years. Patient, tumour, and therapeutic details were collected and analysed.
From an analysis of 448 patients treated between 1994 and 2014, a total of 28 patients with a mean age of 53.0 years and mean PCI of 3.3 were included. The overall median survival was 11.0 years (min 5.0; max 27.9). The predictors completeness of cytoreduction (CC-0) and PCI<6 were present in 22/28 patients. 12/28 patients developed at a median of 9.6 years tumour recurrence, and was associated with inferior median overall survival compared to patients without recurrence (8.8 years vs. not reached; p = 0.002).
Long-term survival and even cure are possible in patients with PM of GC treated with CRS and HIPEC. Completeness of cytoreduction and low PCI seemed to be crucial. Further studies are needed in order to improve existing selection criteria.
胃癌（GC）的腹膜转移（PM）较为常见（17%），且与生存预后不良相关。尽管细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）已被证实可使部分患者获益，提高生存时间，但仅小部分患者能够达到长期生存。本研究旨在收集并分析全球范围内接受 CRS 和 HIPEC 治疗、且具有长期生存的患者队列，以探索相关患者特征。
我们向腹膜表面肿瘤国际协会（PSOGI）的所有合作成员发放了调查问卷。纳入标准为：经组织病理学证实的 GC 腹膜转移，接受 CRS 和 HIPEC 治疗，总生存时间>5 年。收集并分析患者、肿瘤和治疗相关信息。
在对 1994 年至 2014 年间接受治疗的 448 例患者进行分析后，共纳入 28 例患者，平均年龄为 53.0 岁，平均 PCI 为 3.3。总体中位生存时间为 11.0 年（最小 5.0 年，最大 27.9 年）。完全性肿瘤细胞减灭术（CC-0）和 PCI<6 的预测因素存在于 22/28 例患者中。28 例患者中有 12 例在中位时间 9.6 年后复发肿瘤，与未复发患者相比，中位总生存时间更差（8.8 年 vs. 未达到；p=0.002）。
接受 CRS 和 HIPEC 治疗的 GC 腹膜转移患者可获得长期生存甚至治愈。肿瘤细胞减灭术的完全程度和低 PCI 似乎是关键因素。需要进一步研究以改进现有的选择标准。
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