Zhangzhou Affiliated Hospital of Fujian Medical University'sDepartment of Gastric Surgery, No.59 Sheng-li Road, Zhangzhou City, Fujian Province, China.
Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou City, Fujian Province, China.
World J Surg Oncol. 2024 Sep 11;22(1):244. doi: 10.1186/s12957-024-03526-y.
Clinical T4 (cT4) stage gastric cancer presents with frequent postoperative recurrence and poor prognosis. This study is to evaluate the oncological efficacy of laparoscopic radical total gastrectomy combined with postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with cT4N + M0 gastric cancer who received neoadjuvant chemotherapy.
We reviewed the clinicopathological data of 174 patients with clinical T4 gastric cancer who underwent neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy between June 2017 and December 2021. Among them, 142 were included in the non-HIPEC group, and 32 in the HIPEC group. Patients in both groups were paired based on propensity score in a 2:1 ratio to assess disparities in tumor recurrence and long-term survival.
After matching, there were no significant differences in the clinicopathological data between the two groups. The peritoneum (16.1%) and distant organs (10.9%) were the most frequent locations for recurrence. Prior to matching, the recurrence rates were similar at all sites for both groups. Compared with those in the non-HIPEC cohort, the recurrence rates at all sites, the lung, and the peritoneum were notably lower in the HIPEC cohort. Prior to matching, the 3-year overall survival and disease-free survival rates were similar between the two groups; following matching, the HIPEC group exhibited notably greater survival rates than did the non-HIPEC group. The disparities in survival rates between the groups became even more pronounced after conducting a stratified analysis among patients with stage III disease.
Neoadjuvant chemotherapy combined with prophylactic HIPEC after laparoscopic radical gastrectomy can effectively reduce the rate of peritoneal metastasis in patients with cT4N + M0 advanced gastric cancer and significantly improve the prognosis of such patients, which is of great clinical value.
临床 T4（cT4）期胃癌术后复发率高，预后差。本研究旨在评估新辅助化疗后腹腔镜根治性全胃切除术联合术后预防性腹腔内热灌注化疗（HIPEC）在接受新辅助化疗的 cT4N+M0 胃癌患者中的肿瘤学疗效。
回顾性分析 2017 年 6 月至 2021 年 12 月接受新辅助化疗后行腹腔镜根治性全胃切除术的 174 例临床 T4 期胃癌患者的临床病理资料。其中，142 例患者纳入非 HIPEC 组，32 例患者纳入 HIPEC 组。采用倾向评分 2:1 配对法比较两组患者肿瘤复发和长期生存差异。
匹配后，两组患者的临床病理资料差异无统计学意义。腹膜（16.1%）和远处器官（10.9%）是复发的最常见部位。匹配前，两组各部位的复发率相似。与非 HIPEC 组相比，HIPEC 组各部位、肺部和腹膜的复发率明显降低。匹配前，两组患者的 3 年总生存率和无病生存率相似；匹配后，HIPEC 组的生存率明显高于非 HIPEC 组。分层分析显示，在 III 期疾病患者中，两组间的生存差异更为明显。
新辅助化疗联合腹腔镜根治性全胃切除术后预防性 HIPEC 可有效降低 cT4N+M0 进展期胃癌患者腹膜转移率，显著改善患者预后，具有重要的临床价值。
Zotero 插件
