Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Haidian District, 52 Fucheng Road, Beijing, 100142, China.
World J Surg Oncol. 2023 Jul 12;21(1):204. doi: 10.1186/s12957-023-03085-8.
The prognosis of gastric cancer (GC) patients with positive peritoneal cytology (CY1) without other distant metastasis is poor, and there are no standard treatment strategies. Our study aimed to compare the survival outcomes of CY1 GC patients receiving chemotherapy or surgery as initial treatment.
From February 2017 to January 2020, clinical and pathological data of patients diagnosed with CY1 GC without other distant metastasis in the Peking University Cancer Hospital was reviewed. Patients were divided into two groups: chemotherapy-initial group and surgery-initial group. In chemotherapy-initial group, patients received preoperative chemotherapy initially. According to the treatment response, the patients were divided into three subgroups: conversion gastrectomy group, palliative gastrectomy group, and further systematic chemotherapy group. In surgery-initial group, patients underwent gastrectomy followed by postoperative chemotherapy.
A total of 96 CY1 GC patients were included with 48 patients in each group. In chemotherapy-initial group, preoperative chemotherapy yielded an objective response rate of 20.8% and disease control rate of 87.5%. Conversion to CY0 after preoperative chemotherapy was obtained in 24 (50%) patients. The median overall survival was 36.1 months in chemotherapy-initial group and 29.7 months in surgery-initial group (p = 0.367). The median progression-free survival was 18.1 months in chemotherapy-initial group and 16.1 months in surgery-initial group (p = 0.861). The 3-year overall survival rates were 50.0% and 47.9%, respectively. In chemotherapy-initial group, twenty-four patients who converted to CY0 by preoperative chemotherapy and received surgery obtained a significantly better prognosis. The median overall survival was still not reached in these patients.
There was no significant difference in survival outcomes between chemotherapy-initial group and surgery-initial group. CY1 GC patients who converted to CY0 by preoperative chemotherapy and received radical surgery could obtain a favorable long-term prognosis. Further investigation should focus on preoperative chemotherapy to eliminate peritoneal cancer cell.
This study is retrospectively registered.
伴有阳性腹膜细胞学（CY1）而无其他远处转移的胃癌（GC）患者预后较差，目前尚无标准的治疗策略。本研究旨在比较初始接受化疗或手术治疗的 CY1 GC 患者的生存结局。
回顾性分析 2017 年 2 月至 2020 年 1 月于北京大学肿瘤医院诊断为无其他远处转移的 CY1 GC 患者的临床和病理资料。患者分为两组：化疗初始组和手术初始组。化疗初始组患者首先接受术前化疗。根据治疗反应，患者分为三组：转化性胃切除术组、姑息性胃切除术组和进一步系统化疗组。手术初始组患者接受胃切除术，术后行辅助化疗。
共纳入 96 例 CY1 GC 患者，每组 48 例。化疗初始组术前化疗的客观缓解率为 20.8%，疾病控制率为 87.5%。24 例（50%）患者经术前化疗后转为 CY0。化疗初始组的中位总生存期为 36.1 个月，手术初始组为 29.7 个月（p=0.367）。化疗初始组的中位无进展生存期为 18.1 个月，手术初始组为 16.1 个月（p=0.861）。3 年总生存率分别为 50.0%和 47.9%。在化疗初始组中，24 例经术前化疗转为 CY0 并接受手术的患者获得了显著更好的预后。这些患者的中位总生存期仍未达到。
化疗初始组与手术初始组的生存结局无显著差异。经术前化疗转化为 CY0 并接受根治性手术的 CY1 GC 患者可获得良好的长期预后。进一步的研究应集中在消除腹膜癌细胞的术前化疗上。
本研究为回顾性注册。
