Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China.
Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gastric Cancer. 2024 Mar;27(2):387-399. doi: 10.1007/s10120-023-01452-8. Epub 2023 Dec 24.
Data on the long-term oncological outcomes of patients who undergo conversion surgery (CS) in gastric cancer (GC) patients with peritoneal metastasis (PM) are limited.
GC patients with PM who received intraperitoneal (ip) and systemic chemotherapy between April 2015 and January 2021 were enrolled. Multivariate analysis was performed to identify risk factors associated with survival. Clinicopathological and survival outcomes were compared between those with CS and those without CS (NCS). The paclitaxel (PTX) plus tegafur-gimeracil-oteracil potassium capsules (S-1) (PS) + ip PTX and oxaliplatin plus S-1 (SOX) + ip PTX groups were matched in a 1:1 ratio using propensity score matching. Oncological and survival data were collected and analyzed.
A total of 540 patients who received ip chemotherapy via subcutaneous port and systemic chemotherapy were analyzed and 268 patients were enrolled, including 113 who underwent CS and 155 who did not. Overall survival (OS) were 27.0 months and 11.8 months in the CS and NCS groups (P < 0.0001), respectively. R0 resection was an independent prognostic factor for patients who underwent CS. The OS of patients with or without ovariectomy was 21.3 or 12.0 months (P < 0.0001). No difference of clinicopathological and survival outcomes was found between the PS + ip PTX and SOX + ip PTX groups.
Conversion therapy is safe and adverse events were manageable. CS improves the survival of GC patients with PM after ip and systemic chemotherapy. R0 is an important prognostic factor. Furthermore, outcomes are comparable between the PS + ip PTX and SOX + ip PTX groups.
关于接受转化手术（CS）的胃癌（GC）伴腹膜转移（PM）患者的长期肿瘤学结果的数据有限。
纳入 2015 年 4 月至 2021 年 1 月期间接受腹腔内（ip）和全身化疗的 GC 伴 PM 患者。采用多变量分析确定与生存相关的危险因素。比较 CS 组和非 CS 组（NCS）患者的临床病理和生存结局。采用倾向评分匹配（PSM）将紫杉醇（PTX）加替加氟-吉美嘧啶-奥替拉西钾胶囊（S-1）（PS）+ipPTX 和奥沙利铂加 S-1（SOX）+ipPTX 两组按 1:1 比例匹配。收集和分析肿瘤学和生存数据。
对 540 例接受皮下港腹腔化疗和全身化疗的患者进行分析，纳入 268 例患者，其中 113 例行 CS，155 例行非 CS。CS 组和 NCS 组的总生存期（OS）分别为 27.0 个月和 11.8 个月（P<0.0001）。CS 患者中 R0 切除是独立的预后因素。行或不行卵巢切除术患者的 OS 分别为 21.3 个月或 12.0 个月（P<0.0001）。PSM 后 PS+ipPTX 和 SOX+ipPTX 两组患者的临床病理和生存结局无差异。
转化治疗是安全的，不良事件是可控的。CS 提高了 GC 伴 PM 患者在接受 ip 和全身化疗后的生存率。R0 是一个重要的预后因素。此外，PS+ipPTX 和 SOX+ipPTX 两组的结局相当。
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