Yu T, Ma F H, An Q, Cao X L, Xiao G, Wu G J
Department of General Surgery, Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2023 Sep 26;103(36):2867-2873. doi: 10.3760/cma.j.cn112137-20230319-00435.
To evaluate the safety and efficacy of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) on elderly patients diagnosed with locally advanced gastric cancer based on a propensity score matching analysis. Clinical data of elderly patients with locally advanced gastric cancer who underwent radical gastrectomy in Beijing Hospital from January 2017 to December 2021 were retrospectively collected. According to whether HIPEC was used, the patients were divided into HIPEC group (radical gastrectomy combined with HIPEC) and control group (radical gastrectomy alone), and 29 patients in HIPEC group and 122 patients in control group. After 1∶1 matching of PSM, there were 28 patients in each group. The clinicopathological data, surgical data, postoperative recovery and long-term survival of the two groups were compared and analyzed. Before PSM, the mean age in the HIPEC group was (70.7±4.0) years, and in the control group was (73.1±5.8) years (=0.011). After PSM, the mean age in the HIPEC group was (70.9±3.9) years, and it was (71.8±5.4) years in the control group (=0.739). Before PSM, the incidence of postoperative complications was 20.7% (6 cases) in the HIPEC group and 26.2% (32 cases) in the control group (=0.639). After PSM, the incidence of postoperative complications was 21.4% (6 cases) in the HIPEC group and 14.3% (4 cases) in the control group (=0.730). Before PSM, the mean duration of hospitalization after radical gastrectomy was (13.6±7.6) days in HIPEC group and (16.2±13.0) days in control group, respectively (=0.312). After PSM, the mean duration of hospitalization after radical gastrectomy was (13.7±7.8) days in HIPEC group and (15.4±9.7) days in control group, respectively (=0.479). Before PSM, the 1-and 3-year overall survival rates of the HIPEC group were 88.2% and 69.7%, and 88.0% and 66.1% for control group, respectively, with no statistical difference between the two groups in overall survival (=0.499). After PSM, the 1-and 3-year overall survival rates of the HIPEC group were 86.8% and 69.7%, and 93.1% and 67.5% for control group, respectively, with no statistical difference between the two groups in overall survival (=0.425). Before PSM, the 1-and 3-year disease-free survival rates of the HIPEC group were 88.2% and 67.1%, and 87.8% and 64.3% for control group, respectively, with no statistical difference between the two groups in disease-free survival (=0.863). After PSM, the 1-and 3-year disease-free survival rates of the HIPEC group were 88.2% and 62.8%, and 93.7% and 64.7% for control group, respectively, with no statistical difference between the two groups in disease-free survival (=0.804). Radical surgery combined with HIPEC for elderly patients with gastric cancer does not increase postoperative complications and postoperative recovery time. However, there was no significant difference in overall survival and disease-specific survival between the two groups.
基于倾向评分匹配分析，评估预防性腹腔内热化疗（HIPEC）对诊断为局部晚期胃癌的老年患者的安全性和有效性。回顾性收集2017年1月至2021年12月在北京医院接受根治性胃切除术的老年局部晚期胃癌患者的临床资料。根据是否使用HIPEC，将患者分为HIPEC组（根治性胃切除术联合HIPEC）和对照组（单纯根治性胃切除术），HIPEC组29例，对照组122例。经PSM 1∶1匹配后，每组各有28例患者。比较并分析两组患者的临床病理资料、手术资料、术后恢复情况及长期生存情况。PSM前，HIPEC组的平均年龄为（70.7±4.0）岁，对照组为（73.1±5.8）岁（P = 0.011）。PSM后，HIPEC组的平均年龄为（70.9±3.9）岁，对照组为（71.8±5.4）岁（P = 0.739）。PSM前，HIPEC组术后并发症发生率为20.7%（6例），对照组为26.2%（32例）（P = 0.639）。PSM后，HIPEC组术后并发症发生率为21.4%（6例），对照组为14.3%（4例）（P = 0.730）。PSM前，HIPEC组根治性胃切除术后平均住院时间分别为（13.6±7.6）天，对照组为（16.2±13.0）天（P = 0.312）。PSM后，HIPEC组根治性胃切除术后平均住院时间分别为（13.7±7.8）天，对照组为（15.4±9.7）天（P = 0.479）。PSM前，HIPEC组1年和3年总生存率分别为88.2%和69.7%，对照组分别为88.0%和66.1%，两组总生存率差异无统计学意义（P = 0.499）。PSM后，HIPEC组1年和3年总生存率分别为86.8%和69.7%，对照组分别为93.1%和67.5%，两组总生存率差异无统计学意义（P = 0.425）。PSM前，HIPEC组1年和3年无病生存率分别为88.2%和67.1%，对照组分别为87.8%和64.3%，两组无病生存率差异无统计学意义（P = 0.863）。PSM后，HIPEC组1年和3年无病生存率分别为88.2%和62.8%，对照组分别为93.7%和64.7%，两组无病生存率差异无统计学意义（P = 0.804）。根治性手术联合HIPEC治疗老年胃癌患者不会增加术后并发症和术后恢复时间。然而，两组患者的总生存率和疾病特异性生存率无显著差异。
