Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
School of Public Health, National Defense Medical Center, Taipei, Taiwan; Teaching Office, Tri-Service General Hospital, National Defense Medical Center, Taiwan.
Eur J Surg Oncol. 2022 Sep;48(9):1972-1979. doi: 10.1016/j.ejso.2022.04.018. Epub 2022 Apr 27.
Patients with clinical T4 gastric cancers have high recurrence rates and low 5-year overall survival (OS) despite radical gastrectomy with D2 lymphadenectomy and adjuvant chemotherapy. The invisible peritoneal metastasis may result in local recurrence due to the tumor invading the serosa and nearby organs. Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) has been suggested as an adjuvant treatment strategy in these patients. We evaluated the efficacy of prophylactic HIPEC post-gastrectomy for patients with clinical T4 gastric cancer.
We retrospectively reviewed data from 132 patients with clinical T4 gastric cancer who underwent gastrectomy + D2 lymphadenectomy between 2014 and 2020. Thirty-five of these patients also underwent prophylactic HIPEC perioperatively. We used propensity score matching (PSM) to reduce selection bias. We evaluated the risk factors for recurrence and compared the OS and disease-free survival (DFS) between the gastrectomy and prophylactic HIPEC groups.
A total of 132 eligible patients were included in the study. Seventy preoperative patient characteristics were homogeneous post-PSM. Prophylactic HIPEC seemed to reduce the risk of postoperative peritoneal recurrence but did not influence the risk of distant metastasis. The risk factors for recurrence included advanced N stage, ascites, and lymphovascular invasion. OS (adjusted hazard ratio, 0.37; 95% CI, 0.17 to 0.81; p = 0.035) and DFS (adjusted hazard ratio, 0.33; 95% CI, 0.15 to 0.72; p = 0.017) were better in the prophylactic HIPEC group than in the gastrectomy alone group.
Prophylactic HIPEC plus radical gastrectomy can reduce peritoneal recurrence and improve OS and DFS in patients with clinical T4 gastric cancer.
尽管进行了根治性胃切除术加 D2 淋巴结清扫术和辅助化疗，临床 T4 期胃癌患者仍有较高的复发率和 5 年总生存率（OS）较低。由于肿瘤侵犯浆膜和附近器官，无形的腹膜转移可能导致局部复发。预防性腹腔热灌注化疗（HIPEC）已被建议作为这些患者的辅助治疗策略。我们评估了根治性胃切除术后预防性 HIPEC 对临床 T4 期胃癌患者的疗效。
我们回顾性分析了 2014 年至 2020 年间接受胃切除术+D2 淋巴结清扫术的 132 例临床 T4 期胃癌患者的数据。其中 35 例患者还接受了围手术期预防性 HIPEC。我们使用倾向评分匹配（PSM）来减少选择偏倚。我们评估了复发的风险因素，并比较了胃切除术和预防性 HIPEC 组的 OS 和无病生存率（DFS）。
共有 132 例符合条件的患者纳入研究。经过 PSM 后，术前 70 项患者特征具有同质性。预防性 HIPEC 似乎降低了术后腹膜复发的风险，但不影响远处转移的风险。复发的风险因素包括晚期 N 分期、腹水和淋巴血管侵犯。OS（调整后的危险比，0.37；95%CI，0.17 至 0.81；p=0.035）和 DFS（调整后的危险比，0.33；95%CI，0.15 至 0.72；p=0.017）在预防性 HIPEC 组优于单纯胃切除术组。
预防性 HIPEC 联合根治性胃切除术可降低临床 T4 期胃癌患者的腹膜复发率，并提高 OS 和 DFS。
