Bhutiani Neal, Seo Y David, Robinson Kristen A, White Michael G, Ikoma Naruhiko, Mansfield Paul F, Li Jenny J, Murphy Mariela Blum, Ajani Jaffer A, Badgwell Brian D
The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX, USA.
The University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Houston, TX, USA.
Eur J Surg Oncol. 2025 Jan;51(1):108790. doi: 10.1016/j.ejso.2024.108790. Epub 2024 Oct 25.
Prior work has established hyperthermic intraperitoneal chemotherapy (HIPEC) administration as a safe treatment option for select patients with gastric adenocarcinoma and carcinomatosis. However, identifying patients who will maximally benefit from HIPEC remains unclear. This study assessed a single-institution experience with HIPEC for metastatic gastric cancer to identify variables associated with improved survival.
A database of patients treated for metastatic gastric adenocarcinoma at MD Anderson Cancer Center from 2013 to 2022 was queried for patients undergoing HIPEC as part of their treatment regimen. Patients were stratified by overall survival (OS)≥36 months or <36 months and assessed along demographic and clinicopathologic variables to identify factors associated with OS ≥ 36 months.
Among 104 patients, 1,2, and 3-year OS from diagnosis was 89 %,44 %, and 18 %. Patients with OS ≥ 36 months were more likely to have moderately differentiated tumors, positive cytology only (i.e. no visible carcinomatosis), and lower peritoneal cancer index (PCI) than those with OS < 36 months (p = 0.002, p = 0.01, p = 0.001,respectively). Groups did not otherwise differ with respect to demographic parameters or treatment or pathologic details. Among patients who underwent gastrectomy, those with OS < 36 months had higher pathologic T and N category (p = 0.003 and p = 0.02, respectively). Postoperative mortality was zero in both groups among patients undergoing gastrectomy.
HIPEC may provide more durable survival benefit among patients with metastatic gastric cancer with moderately differentiated disease, low PCI, and positive cytology alone. Additionally, among patients who undergo gastrectomy, higher final pathologic T and N category are associated with worse survival. Trials are needed to compare 3-year OS rates in patients treated with HIPEC versus systemic therapy alone.
先前的研究已确定，热灌注化疗（HIPEC）对特定的胃腺癌和癌性腹膜炎患者是一种安全的治疗选择。然而，确定哪些患者将从HIPEC中最大程度获益仍不明确。本研究评估了单机构使用HIPEC治疗转移性胃癌的经验，以确定与生存改善相关的变量。
查询MD安德森癌症中心2013年至2022年接受转移性胃腺癌治疗患者的数据库，以获取接受HIPEC作为其治疗方案一部分的患者。根据总生存期（OS）≥36个月或<36个月对患者进行分层，并根据人口统计学和临床病理变量进行评估，以确定与OS≥36个月相关的因素。
104例患者中，诊断后1年、2年和3年的OS分别为89%、44%和18%。与OS<36个月的患者相比，OS≥36个月的患者更有可能患有中度分化肿瘤、仅细胞学阳性（即无可见癌性腹膜炎）和较低的腹膜癌指数（PCI）（分别为p = 0.002、p = 0.01、p = 0.001）。两组在人口统计学参数、治疗或病理细节方面没有其他差异。在接受胃切除术的患者中，OS<36个月的患者病理T和N分期更高（分别为p = 0.003和p = 0.02）。接受胃切除术的两组患者术后死亡率均为零。
HIPEC可能为患有中度分化疾病、低PCI且仅细胞学阳性的转移性胃癌患者提供更持久的生存益处。此外，在接受胃切除术的患者中，最终病理T和N分期较高与生存较差相关。需要进行试验来比较接受HIPEC治疗与仅接受全身治疗的患者的3年OS率。
