Lee Ting-Ying, Liao Guo-Shiou, Fan Hsiu-Lung, Hsieh Chung-Bao, Chen Teng-Wei, Chan De-Chuan
Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2 Cheng-Kong Rd., Neihu District, Taipei 114, Taiwan.
J Oncol. 2021 Nov 10;2021:5459432. doi: 10.1155/2021/5459432. eCollection 2021.
Patients with advanced gastric cancer (AGC) with peritoneal carcinomatosis (PC) usually have poor outcomes and high mortality risk, even with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This study analyzed the prognostic factors of AGC with PC and evaluated laparoscopic HIPEC (LHIPEC) plus neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) as a conversion surgery for AGC patients with PC with a poor initial prognosis. . We retrospectively evaluated 127 patients with AGC and PC from January 1, 2012, to March 1, 2020. After the exclusion of 32 ineligible patients, the conversion group comprised 34 patients who underwent LHIPEC + NIPS as a conversion surgery followed by CRS plus HIPEC. The CRS + HIPEC group included 15 patients who underwent CRS with HIPEC alone. Additionally, the C/T group comprised 23 patients who received systemic chemotherapy, and the palliative group comprised 23 patients who received only conservative therapy or palliative gastrectomy.
The conversion group demonstrated a significantly better mean overall survival compared to the CRS + HIPEC, C/T, and palliative groups ( < 0.001). Patients in the conversion group who underwent LHIPEC + NIPS had significantly decreased peritoneal cancer index (PCI) scores ( < 0.001) and ascites (=0.003). Malignant ascites amount also significantly decreased after treatment in the LHIPEC + NIPS group ( < 0.001).
LHIPEC + NIPS can significantly improve the overall survival, the PCI score, and malignant ascites amount in peritoneal cytology-positive gastric cancer with PC, and an initially high PCI score. Therefore, it may be a feasible conversion strategy for AGC patients with PC.
伴有腹膜转移癌（PC）的晚期胃癌（AGC）患者通常预后较差，死亡风险高，即便接受了细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）亦是如此。本研究分析了AGC伴PC的预后因素，并评估了腹腔镜HIPEC（LHIPEC）联合新辅助腹腔及全身化疗（NIPS）作为初始预后较差的AGC伴PC患者的一种转化手术。我们回顾性评估了2012年1月1日至2020年3月1日期间127例AGC伴PC患者。排除32例不符合条件的患者后，转化组包括34例接受LHIPEC + NIPS作为转化手术，随后接受CRS加HIPEC的患者。CRS + HIPEC组包括15例仅接受CRS加HIPEC手术的患者。此外，C/T组包括23例接受全身化疗的患者，姑息治疗组包括23例仅接受保守治疗或姑息性胃切除术的患者。
与CRS + HIPEC组、C/T组和姑息治疗组相比，转化组的平均总生存期显著更长（<0.001）。接受LHIPEC + NIPS的转化组患者的腹膜癌指数（PCI）评分显著降低（<0.001），腹水情况也有所改善（=0.003）。LHIPEC + NIPS组治疗后恶性腹水量也显著减少（<0.001）。
LHIPEC + NIPS可显著提高PC阳性且初始PCI评分较高的腹膜细胞学阳性胃癌患者的总生存期、PCI评分和减少恶性腹水量。因此，它可能是AGC伴PC患者一种可行的转化策略。
