Hayler Raymond, Domingos Natalie, Ashrafizadeh Amir, Wijayawardana Ruwanthi, Ahmadi Nima, Liauw Winston, Morris David
Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Australia.
School of Clinical Medicine, St George & Sutherland Campus, UNSW Medicine & Health, Kogarah, Sydney, Australia.
World J Surg Oncol. 2025 Mar 19;23(1):93. doi: 10.1186/s12957-025-03749-7.
Gastric cancer is a major cause of cancer mortality, with poorer prognosis in the presence of peritoneal metastases as low as 2.8-9 months. Systemic therapy has a limited role. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival. This study evaluates survival of patients with gastric cancer and peritoneal metastases (GCPM) undergoing CRS and HIPEC at an Australian centre.
A retrospective analysis was conducted on a prospectively collected database of patients who underwent CRS and HIPEC for GCPM from January 2009 to December 2023. Data included demographics, perioperative factors, histopathology and survival.
Twenty-four patients were identified, with median postoperative overall survival of 11.7 months (95% CI 8.6-34.2 months). Most patients had poorly differentiated adenocarcinoma (n = 23, 96%), with 14 (58%) exhibiting signet cell pathology. 62% (n = 15) received preoperative chemotherapy. Median PCI was 5, with a CC score of 0 in 96% of patients (n = 23). Clavien-Dindo III/IV morbidity was noted in 8 patients (33%) with no perioperative mortality. No survival differences were found between those with signet cell pathology and those without (10.6 vs. 11.7 months, p = 0.83), nor between those receiving preoperative chemotherapy and those who did not (11.7 vs. 10.6 months, p = 0.60). Age, sex, PCI, CC and tumour markers demonstrated correlations with survival in linear regression, but no individual factor significantly influenced outcomes.
CRS and HIPEC for low volume GCPM should be considered in select patients.
胃癌是癌症死亡的主要原因，存在腹膜转移时预后较差，生存期低至2.8 - 9个月。全身治疗作用有限。细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）已被证明可提高生存率。本研究评估了在澳大利亚一家中心接受CRS和HIPEC治疗的胃癌伴腹膜转移（GCPM）患者的生存情况。
对2009年1月至2023年12月期间因GCPM接受CRS和HIPEC治疗的患者的前瞻性收集数据库进行回顾性分析。数据包括人口统计学、围手术期因素、组织病理学和生存情况。
共纳入24例患者，术后中位总生存期为11.7个月（95%可信区间8.6 - 34.2个月）。大多数患者为低分化腺癌（n = 23，96%），其中14例（58%）表现为印戒细胞病理特征。62%（n = 15）的患者接受了术前化疗。中位腹膜癌指数（PCI）为5，96%（n = 23）的患者并发症评分（CC）为0。8例患者（33%）出现Clavien - Dindo III/IV级并发症，无围手术期死亡。印戒细胞病理特征患者与无该特征患者之间未发现生存差异（10.6个月对11.7个月，p = 0.83），接受术前化疗患者与未接受术前化疗患者之间也未发现生存差异（11.7个月对10.6个月，p = 0.60）。年龄、性别、PCI、CC和肿瘤标志物在线性回归中显示与生存相关，但没有单个因素对结局有显著影响。
对于部分低负荷GCPM患者，应考虑行CRS和HIPEC治疗。
