基于实验室检测的胃癌患者腹腔内热化疗是安全的：单中心中国研究分析。
Hyperthermic intraperitoneal chemotherapy for patients with gastric cancer based on laboratory tests is safe: a single Chinese center analysis.
机构信息
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of General Surgery, The Central Hospital of Jia Mu Si City, Jia Mu Si, Hei Long Jiang, China.
出版信息
BMC Surg. 2022 Sep 18;22(1):342. doi: 10.1186/s12893-022-01795-6.
PURPOSE
About 15%-40% of gastric cancer patients have peritoneal metastasis, which leads to poor prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) is considered to be an effective treatment for these patients. This study evaluated the efficacy and safety of HIPEC in patients with gastric cancer diagnosed from laboratory tests.
METHODS
The clinical and pathological data of 63 patients with gastric cancer who underwent HIPEC in 2017-2021 were prospectively recorded. Fifty-five patients underwent cytoreductive surgery + HIPEC, and eight patients received HIPEC alone. The factors associated with HIPEC safety and efficacy were analyzed. The primary endpoint was overall survival.
RESULTS
The average patient age was 54.84 years and 68.3% of patients were male. Moreover, 79.4% of patients had a peritoneal carcinoma index (PCI) score of ≤ 7 and 61.9% had a completeness of cytoreduction score of 0. Because of peritoneal metastasis, 29 patients (46.03%) were classified as stage IV. Laboratory tests showed no differences in pre-HIPEC blood test results compared to post-HIPEC results after removing the effects of surgery. HIPEC treatment did not cause obvious liver or kidney damage. Serum calcium levels decreased significantly after HIPEC (P = 0.0018). The Karnofsky performance status (KPS) score correlated with the patient's physical function and improved after HIPEC (P = 0.0045). In coagulation tests, FDP (P < 0.0001) and D-dimer (P < 0.0001) levels increased significantly and CA242 (P = 0.0159), CA724 (P < 0.0001), and CEA (P < 0.0014) levels decreased significantly after HIPEC. Completeness of cytoreduction score was an independent prognostic factor. HIPEC did not show a survival benefit in patients with gastric cancer (P = 0.5505).
CONCLUSION
HIPEC is a safe treatment for patients with gastric cancer with peritoneal metastasis based on the laboratory tests. However, the efficacy of this treatment on gastric-derived peritoneal metastases requires further confirmation.
目的
约 15%-40%的胃癌患者存在腹膜转移，导致预后不良。腹腔内热灌注化疗（HIPEC）被认为是治疗此类患者的有效方法。本研究评估了实验室检查诊断为胃癌患者行 HIPEC 的疗效和安全性。
方法
前瞻性记录了 2017-2021 年期间行 HIPEC 的 63 例胃癌患者的临床和病理资料。55 例行细胞减灭术+ HIPEC，8 例行 HIPEC 单独治疗。分析与 HIPEC 安全性和疗效相关的因素。主要终点为总生存期。
结果
患者平均年龄为 54.84 岁，68.3%为男性。此外，79.4%的患者腹膜癌指数（PCI）评分≤7，61.9%的患者肿瘤细胞减灭术完全程度评分（CCR）为 0。由于腹膜转移，29 例（46.03%）患者被归类为 IV 期。去除手术影响后，HIPEC 前后的实验室检查结果无明显差异。HIPEC 治疗并未导致明显的肝肾功能损害。HIPEC 后血清钙水平显著下降（P=0.0018）。卡氏功能状态评分（KPS）与患者的身体功能相关，HIPEC 后有所改善（P=0.0045）。在凝血试验中，纤维蛋白降解产物（FDP）（P<0.0001）和 D-二聚体（P<0.0001）水平显著升高，CA242（P=0.0159）、CA724（P<0.0001）和 CEA（P<0.0014）水平显著降低。肿瘤细胞减灭术完全程度评分是独立的预后因素。HIPEC 并未显示出对胃癌患者的生存获益（P=0.5505）。
结论
基于实验室检查，HIPEC 是治疗胃癌伴腹膜转移患者的一种安全治疗方法。然而，该治疗方法对胃源性腹膜转移的疗效仍需进一步证实。
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