Chen Zhi-Xiong, Li Jin, Liu Wen-Bin, Zhang Shou-Ru, Sun Hao
Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China.
Department of Ultrasound, The Fifth People's Hospital of Chongqing, Chongqing 400062, China.
World J Clin Cases. 2022 Feb 16;10(5):1498-1507. doi: 10.12998/wjcc.v10.i5.1498.
Almost all elderly patients with peritoneal metastatic gastric cancer (PGC) are unlikely to tolerate cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and adjuvant chemotherapy. However, determining how to optimize the treatment strategy for such patients has always been a clinical problem. Both HIPEC and palliative adjuvant chemotherapy can benefit patients with PGC. Therefore, optimizing HIPEC and chemotherapy regimens has potential clinical value in reducing side effects, and improving treatment tolerance and clinical effectiveness.
To explore the effect of HIPEC containing elemene, which is an anti-cancer component extracted in traditional Chinese herbal medicine, combined with reduced capecitabine and oxaliplatin (CapeOx) chemotherapy regimens, in elderly patients with PGC.
In the present study, 39 of 52 elderly PGC patients were included and assigned to different HIPEC treatment groups [lobaplatin group (group L) and mixed group (group M)] for analysis. Lobaplatin was used for all three HIPECs in group L. In group M, lobaplatin was used in the middle of the three HIPECs, and elemene was used for the first and third HIPEC. After HIPEC, patients received CapeOx chemotherapy. The incidence of complications (abdominal infection, lung infection, and urinary tract infection), myelosuppression, immune function (CD4/CD8 ratio), average length of hospital stay, and prognosis were compared between these two groups.
There was no significant difference in the incidence of complications between the two groups during hospitalization ( > 0.05). Compared to patients in group M, patients in group L exhibited severe myelosuppression ( = 0.027) and increased length of hospital stay ( = 0.045). However, no overall survival benefit was observed in group M. Furthermore, the immune function of patients in group M was less affected ( < 0.001), when compared to that of patients in group L. The multivariate analysis suggested that the cycles of chemotherapy after perfusion significantly affected the prognosis of patients in both groups.
Compared to the lobaplatin-based HIPEC regimen, the administration of elemene reduced the myelosuppression incidence in elderly PGC patients. The present study sheds light on the implementation of this therapeutic strategy for this set of patients.
几乎所有老年腹膜转移性胃癌（PGC）患者都不太可能耐受减瘤手术联合热灌注腹腔化疗（HIPEC）及辅助化疗。然而，确定如何优化这类患者的治疗策略一直是个临床难题。HIPEC和姑息性辅助化疗都能使PGC患者获益。因此，优化HIPEC和化疗方案在减少副作用、提高治疗耐受性和临床疗效方面具有潜在的临床价值。
探讨含中药提取抗癌成分榄香烯的HIPEC联合减量的卡培他滨和奥沙利铂（CapeOx）化疗方案对老年PGC患者的疗效。
在本研究中，52例老年PGC患者中的39例被纳入并分配到不同的HIPEC治疗组[洛铂组（L组）和混合组（M组）]进行分析。L组的三次HIPEC均使用洛铂。M组在三次HIPEC中，中间一次使用洛铂，第一次和第三次使用榄香烯。HIPEC后，患者接受CapeOx化疗。比较两组患者并发症（腹部感染、肺部感染和尿路感染）的发生率、骨髓抑制情况、免疫功能（CD4/CD8比值）、平均住院时间和预后。
两组患者住院期间并发症发生率无显著差异（P>0.05）。与M组患者相比，L组患者出现严重骨髓抑制（P=0.027）且住院时间延长（P=0.045）。然而，M组未观察到总生存获益。此外，与L组患者相比，M组患者的免疫功能受影响较小（P<0.001）。多因素分析表明，灌注后化疗周期对两组患者的预后均有显著影响。
与基于洛铂的HIPEC方案相比，榄香烯的应用降低了老年PGC患者骨髓抑制的发生率。本研究为这组患者实施该治疗策略提供了依据。
