晚期胃癌患者腹腔内化疗的适应证、安全性、疗效及生存获益
Indications, Safety, Efficacy and Survival Benefit of Intraperitoneal Chemotherapy in Patients With Advanced Gastric Cancer.
作者信息
Paraskeva Aikaterini, Triantafyllidis Alexandros, Kazantzi Maria, Theodosopoulos Theodosios
机构信息
Third Department of Surgery, "Evaggelismos" General Hospital, Athens, Greece.
1st Surgical Department, NIMITS Hospital of Athens, Athens, Greece.
出版信息
Cancer Diagn Progn. 2023 Jan 3;3(1):9-16. doi: 10.21873/cdp.10173. eCollection 2023 Jan-Feb.
BACKGROUND/AIM: Advanced gastric cancer remains a significant concern for the medical community mostly due to the locoregional extension of the disease. Most commonly, stomach neoplasms are resectable, but not curable, due to the elevated percentage of peritoneal dissemination after gastrectomy and extensive lymph node dissection. Locoregional intraperitoneal chemotherapy plays a pivotal role in overall survival and prognosis of patients with advanced gastric cancer and shows a high probability of peritoneal dissemination after gastrectomy. In this review, we aimed to collect and present literature data concerning intraperitoneal chemotherapy in advanced stages of gastric cancer as well as evaluate the safety and survival benefit of the procedure.
MATERIALS AND METHODS
We conducted a survey including all randomized controlled trials and clinical trials that were published in the last 30 years. The keywords used were: advanced gastric cancer, intraperitoneal chemotherapy and peritoneal carcinomatosis. We searched for clinical trials in Pubmed, Embase databases and the Cochrane library. Inclusion criteria were: patients with advanced gastric cancer with no macroscopical signs of peritoneal dissemination, who were treated with D2 gastrectomy and received one or more cycles of intraperitoneal chemotherapy. The final review included 20 articles.
RESULTS
The safety of intraperitoneal chemotherapy, as well as the survival benefit of patients were evaluated. The majority of articles denoted that intraperitoneal chemotherapy is a safe procedure without severe or lethal complications. The majority of complications were hematological while non-hematologic complications were also noted. A survival benefit with statistically significant results (p<0.05) was observed in 6 out of 10 randomized controlled trials.
CONCLUSION
Intraperitoneal chemotherapy for advanced gastric cancer is a safe procedure with promising results regarding survival benefit and prognosis. Further patient evaluation is required in order to standardize the type of chemotherapeutic agent and the sufficient dose and cycles for the most appropriate results.
背景/目的：晚期胃癌仍然是医学界的一个重大关注点，主要是因为该疾病的局部区域扩展。最常见的情况是，胃肿瘤可切除，但由于胃切除术后腹膜播散的比例升高以及广泛的淋巴结清扫，无法治愈。局部区域腹腔内化疗在晚期胃癌患者的总生存期和预后中起着关键作用，并且胃切除术后腹膜播散的可能性很高。在本综述中，我们旨在收集并呈现有关晚期胃癌腹腔内化疗的文献数据，并评估该手术的安全性和生存获益。
材料与方法
我们进行了一项调查，纳入了过去30年发表的所有随机对照试验和临床试验。使用的关键词为：晚期胃癌、腹腔内化疗和腹膜癌病。我们在PubMed、Embase数据库和Cochrane图书馆中搜索临床试验。纳入标准为：无腹膜播散宏观体征的晚期胃癌患者，接受D2胃切除术并接受一个或多个周期的腹腔内化疗。最终综述纳入了20篇文章。
结果
评估了腹腔内化疗的安全性以及患者的生存获益。大多数文章表明腹腔内化疗是一种安全的手术，没有严重或致命的并发症。大多数并发症是血液学方面的，同时也注意到了非血液学并发症。在10项随机对照试验中的6项中观察到了具有统计学显著结果（p<0.05）的生存获益。
结论
晚期胃癌的腹腔内化疗是一种安全的手术，在生存获益和预后方面有良好的结果。需要进一步对患者进行评估以规范化疗药物的类型以及为获得最合适结果所需的足够剂量和周期。
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