Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Research Center for Statistics, University of Geneva, Geneva, Switzerland.
World J Surg Oncol. 2021 Aug 17;19(1):245. doi: 10.1186/s12957-021-02351-x.
The optimal treatment in patients with gastric cancer and peritoneal disease remains controversial. Some guidelines indicate palliative treatment only, while others consider surgical treatment in case of positive lavage cytology (CY+) or limited peritoneal disease. Here, we analyzed the role of peritoneal disease in patients with gastric cancer, and the prognostic relevance of response to neoadjuvant therapy.
In this retrospective cohort analysis, we analyzed patients with adenocarcinoma of the stomach or esophago-gastric junction from a single center operated between 2011 and 2019. According to histology and lavage cytology, patients were classified into four risk groups: (A) no peritoneal disease, (B) CY+ who converted to negative lavage cytology (CY-) after neoadjuvant chemotherapy, (C) CY+ without conversion after chemotherapy, and (D) patients with visible peritoneal metastasis.
Overall, n = 172 patients were included. At initial presentation, n = 125 (73%) had no peritoneal disease, and about a third of patients (n = 47, 27%) had microscopic or macroscopic peritoneal disease. Among them, n = 14 (8%) were CY+ without visible peritoneal metastasis, n = 9 converted to CY- after chemotherapy, and in n = 5 no conversion was observed. Median overall survival was not reached in patients who had initially no peritoneal disease and in patients who converted after chemotherapy, resulting in 3-year survival rates of 65% and 53%. In contrast, median overall survival was reduced to 13 months (95% CI 8.7-16.7) in patients without conversion and was 16 months (95% CI 12-20.5) in patients with peritoneal metastasis without difference between the two groups (p = .364). The conversion rate from CY+ to CY- was significantly higher after neoadjuvant treatment with FLOT (5-fluorouracil plus leucovorin, oxaliplatin, and docetaxel) compared to ECF (epirubicin, cisplatin, and 5-fluorouracil) (p = 0.027).
Conversion of CY+ to CY- after neoadjuvant chemotherapy with FLOT is a significant prognostic factor for a better overall survival. Surgical treatment in well-selected patients should therefore be considered. However, peritoneal recurrence remains frequent despite conversion, urging for a better local control.
胃癌合并腹膜疾病患者的最佳治疗方法仍存在争议。一些指南仅建议姑息治疗，而另一些指南则建议在冲洗细胞学阳性（CY+）或腹膜疾病有限的情况下进行手术治疗。在这里，我们分析了腹膜疾病在胃癌患者中的作用，以及新辅助治疗反应的预后相关性。
在这项回顾性队列分析中，我们分析了 2011 年至 2019 年期间在单一中心接受手术的胃腺癌或食管胃结合部腺癌患者。根据组织学和冲洗细胞学，患者被分为四个风险组：（A）无腹膜疾病，（B）CY+在新辅助化疗后转为阴性（CY-），（C）CY+化疗后未转换，（D）可见腹膜转移。
共有 172 名患者纳入研究。初诊时，125 名（73%）患者无腹膜疾病，约三分之一的患者（47 名，27%）存在镜下或肉眼可见的腹膜疾病。其中，14 名（8%）患者为 CY+无可见腹膜转移，9 名患者经化疗后转为 CY-，5 名患者未观察到转换。初诊时无腹膜疾病和化疗后转为阴性的患者中位总生存期未达到，3 年生存率分别为 65%和 53%。相比之下，未转换的患者中位总生存期缩短至 13 个月（95%CI 8.7-16.7），腹膜转移但未转换的患者为 16 个月（95%CI 12-20.5），两组之间无差异（p=0.364）。与 ECF（表柔比星、顺铂和 5-氟尿嘧啶）相比，新辅助治疗采用 FLOT（氟尿嘧啶+亚叶酸、奥沙利铂和多西紫杉醇）后，CY+转为 CY-的转化率明显更高（p=0.027）。
新辅助化疗后 CY+转为 CY-是总体生存更好的显著预后因素。因此，应考虑在选择合适的患者中进行手术治疗。然而，尽管转换后腹膜复发仍很常见，因此仍需更好的局部控制。
