Shinkai Masayuki, Imano Motohiro
Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan.
J Gastrointest Oncol. 2022 Oct;13(5):2169-2177. doi: 10.21037/jgo-21-431.
The prognosis of gastric cancer (GC) patients with peritoneal metastasis (PM) is extremely poor. We developed a new promising regimen combining intraperitoneal () paclitaxel (PTX) with systemic PTX and S-1 chemotherapy for GC patients with PM. However, the value of conversion surgery (CS) for GC patients with PM remains unclear. This study aimed to clarify the clinical effect of CS from our updated previous report.
We retrospectively analyzed 50 GC patients, divided into chemotherapy alone (CTx; n=15) and conversion surgery intervention (CSI; n=35) groups. In the CTx group, chemotherapy was continued in responders, while in the CSI group, surgery was performed in chemotherapy-responders. The primary endpoint was overall survival (OS) of the two groups. The secondary endpoint was the safety of CS.
In the CTx group, 9 of 15 patients (60%) responded to chemotherapy. In the CSI group, PM disappeared in 22 of 35 patients (62.9%), all of whom underwent CS. Post-operative complications occurred in 2 patients (9%) who underwent CS. There were no treatment-related deaths. Regarding OS, there was no significant difference between the two groups [P=0.14; 95% confidence interval (CI), 0.3016-1.197], nor between chemotherapy-responders in the two groups (P=0.059; 95% CI, 0.1473-1.039). However, four patients in the CSI group have survived more than 5 years after CS.
CS may be a promising treatment strategy for some GC patients with PM who have responded to chemotherapy.
伴有腹膜转移（PM）的胃癌（GC）患者预后极差。我们为伴有PM的GC患者研发了一种新的、有前景的方案，即腹腔内（）紫杉醇（PTX）联合全身PTX及S-1化疗。然而，PM的GC患者行转化手术（CS）的价值仍不明确。本研究旨在根据我们之前更新的报告阐明CS的临床效果。
我们回顾性分析了50例GC患者，分为单纯化疗（CTx；n = 15）组和转化手术干预（CSI；n = 35）组。在CTx组中，反应者继续化疗，而在CSI组中，化疗反应者接受手术。主要终点是两组的总生存期（OS）。次要终点是CS的安全性。
在CTx组中，15例患者中有9例（60%）对化疗有反应。在CSI组中，35例患者中有22例（62.9%）的PM消失，所有这些患者均接受了CS。接受CS的2例患者（9%）发生了术后并发症。没有与治疗相关的死亡。关于OS，两组之间没有显著差异[P = 0.14；95%置信区间（CI），0.3016 - 1.197]，两组中化疗反应者之间也没有显著差异（P = 0.059；95% CI，0.1473 - 1.039）。然而，CSI组中有4例患者在CS后存活超过5年。
对于一些对化疗有反应的伴有PM的GC患者，CS可能是一种有前景的治疗策略。
