用于胃癌腹膜转移的腹腔内加压气雾化疗（PIPAC）：立陶宛PIPAC项目的结果

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Gastric Cancer Peritoneal Metastases: Results from the Lithuanian PIPAC Program.

作者信息

Luksta Martynas, Bausys Augustinas, Gendvilaite Neda, Bickaite Klaudija, Rackauskas Rokas, Paskonis Marius, Luksaite-Lukste Raminta, Ranceva Anastasija, Stulpinas Rokas, Brasiuniene Birute, Baltruskeviciene Edita, Lachej Nadezda, Bausiene Juste, Poskus Tomas, Bausys Rimantas, Tulyte Skaiste, Strupas Kestutis

机构信息

Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania.

Department of Abdominal Surgery and Oncology, National Cancer Institute, 08406 Vilnius, Lithuania.

出版信息

Cancers (Basel). 2024 Aug 28;16(17):2992. doi: 10.3390/cancers16172992.

DOI:10.3390/cancers16172992

PMID:39272850

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11394265/

Abstract

BACKGROUND

Peritoneal metastases (PM) of gastric cancer (GC) are considered a terminal condition, with reported median survival ranging from 2 to 9 months. Standard treatment typically involves systemic chemotherapy alone or combined with targeted therapy or immunotherapy, though efficacy is limited. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel technique for treating GC PM, although it remains an experimental treatment under investigation. This study aimed to summarize the outcomes of GC PM treatment with PIPAC from the Lithuanian PIPAC program.

METHODS

All patients who underwent PIPAC for GC PM at Vilnius University Hospital Santaros Klinikos between 2015 and 2022 were included in this retrospective study. The safety of PIPAC was assessed by postoperative complications according to the Clavien-Dindo classification. Efficacy was evaluated based on the peritoneal carcinomatosis index (PCI), ascites dynamics throughout the treatment, and long-term outcomes.

RESULTS

In total, 32 patients underwent 71 PIPAC procedures. Intraoperative and postoperative morbidity related to PIPAC occurred after three (4.2%) procedures. Following PIPAC, there was a tendency towards a decrease in median PCI from 10 (Q1 3; Q3 13) to 7 (Q1 2; Q3 12), = 0.75, and a decrease in median ascites volume from 1300 mL (Q1 500; Q3 3600) at the first PIPAC to 700 mL (Q1 250; Q3 4750) at the last PIPAC, = 0.56; however, these differences were not statistically significant. The median overall survival after PM diagnosis was 12.5 months (95% CI 10-17), and the median survival after the first PIPAC procedure was 5 months (95% CI 4-10).

CONCLUSIONS

PIPAC is a safe and feasible treatment option for GC PM; however, well-designed prospective studies are needed to fully assess its efficacy.

摘要

背景

胃癌（GC）的腹膜转移（PM）被认为是一种终末期疾病，报道的中位生存期为2至9个月。标准治疗通常仅包括全身化疗或联合靶向治疗或免疫治疗，但其疗效有限。腹腔内加压气雾化疗（PIPAC）已成为一种治疗GC PM的新技术，尽管它仍是一种正在研究的实验性治疗方法。本研究旨在总结立陶宛PIPAC项目中使用PIPAC治疗GC PM的结果。

方法

本回顾性研究纳入了2015年至2022年间在维尔纽斯大学医院圣塔罗斯临床中心接受PIPAC治疗GC PM的所有患者。根据Clavien-Dindo分类法，通过术后并发症评估PIPAC的安全性。基于腹膜癌指数（PCI）、整个治疗过程中的腹水动态变化以及长期结局评估疗效。

结果

共有32例患者接受了71次PIPAC治疗。与PIPAC相关的术中及术后发病率在3次（4.2%）治疗后出现。PIPAC治疗后，中位PCI有从10（第一四分位数3；第三四分位数13）降至7（第一四分位数2；第三四分位数12）的趋势，P = 0.75，中位腹水量从首次PIPAC时的1300 mL（第一四分位数500；第三四分位数3600）降至最后一次PIPAC时的700 mL（第一四分位数250；第三四分位数4750），P = 0.56；然而，这些差异无统计学意义。PM诊断后的中位总生存期为12.5个月（95%置信区间10 - 17），首次PIPAC治疗后的中位生存期为5个月（95%置信区间4 - 10）。