基于倾向性评分匹配分析腹腔热灌注化疗预防性应用于局部进展期老年胃癌患者的安全性和疗效

The safety and efficacy of prophylactic hyperthermic intraperitoneal chemotherapy for elderly patients with locally advanced gastric cancer: a propensity score matching analysis

目的基于倾向性评分匹配(PSM)分析腹腔热灌注化疗(HIPEC)预防性应用于局部进展期胃癌患者的安全性和疗效。方法回顾性收集2017—2021年于北京医院行根治性手术治疗的局部进展期老年(≥65岁)胃癌患者的临床资料。根据是否行预防性HIPEC治疗,将患者分为HIPEC组(行根治性手术联合HIPEC,29例)和对照组(仅行单纯根治性手术,122例)。经1∶1 PSM后,HIPEC组和对照组各28例。分析两组患者的临床病理资料、手术资料、术后恢复情况和长期生存结果。结果PSM匹配前,HIPEC组和对照组患者的年龄分别为(70.7±4.0)和(73.1±5.8)岁(P=0.011);PSM匹配后,年龄分别为(70.9±3.9)和(71.8±5.4)岁(P=0.739)。PSM匹配前,HIPEC组和对照组患者术后并发症发生率分别为20.7%(6例)和26.2%(32例)(P=0.639);PSM匹配后,并发症发生率分别为21.4%(6例)和14.3%(4例)(P=0.730)。PSM匹配前,HIPEC组和对照组患者术后住院时间分别为(13.6±7.6)和(16.2±13.0)d(P=0.312);PSM匹配后,住院时间分别为(13.7±7.8)和(15.4±9.7)d(P=0.479)。PSM匹配前,HIPEC组的1、3年累积生存率分别为88.2%、69.7%,对照组分别为88.0%、66.1%(P=0.499);PSM匹配后,HIPEC组的1、3年累积生存率分别为86.8%、69.7%,对照组分别为93.1%、67.5%(P=0.425)。PSM匹配前,HIPEC组的1、3年累积无病生存率分别为88.2%、67.1%,对照组分别为87.8%、64.3%(P=0.863);PSM匹配后,HIPEC组的1、3年累积无病生存率分别为88.2%、62.8%,对照组分别为93.7%、64.7%(P=0.804)。结论老年胃癌患者根治性手术联合HIPEC治疗不增加围手术期并发症发生率和术后恢复时间;两组患者生存率、无病生存率相似。

Objective To evaluate the safety and efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)on elderly patients diagnosed with locally advanced gastric cancer based on a propensity score matching analysis.Methods Clinical data of elderly patients with locally advanced gastric cancer who underwent radical gastrectomy in Beijing Hospital from January 2017 to December 2021 were retrospectively collected.According to whether HIPEC was used,the patients were divided into HIPEC group(radical gastrectomy combined with HIPEC)and control group(radical gastrectomy alone),and 29 patients in HIPEC group and 122 patients in control group.After 1∶1 matching of PSM,there were 28 patients in each group.The clinicopathological data,surgical data,postoperative recovery and long-term survival of the two groups were compared and analyzed.Results Before PSM,the mean age in the HIPEC group was(70.7±4.0)years,and in the control group was(73.1±5.8)years(P=0.011).After PSM,the mean age in the HIPEC group was(70.9±3.9)years,and it was(71.8±5.4)years in the control group(P=0.739).Before PSM,the incidence of postoperative complications was 20.7%(6 cases)in the HIPEC group and 26.2%(32 cases)in the control group(P=0.639).After PSM,the incidence of postoperative complications was 21.4%(6 cases)in the HIPEC group and 14.3%(4 cases)in the control group(P=0.730).Before PSM,the mean duration of hospitalization after radical gastrectomy was(13.6±7.6)days in HIPEC group and(16.2±13.0)days in control group,respectively(P=0.312).After PSM,the mean duration of hospitalization after radical gastrectomy was(13.7±7.8)days in HIPEC group and(15.4±9.7)days in control group,respectively(P=0.479).Before PSM,the 1-and 3-year overall survival rates of the HIPEC group were 88.2%and 69.7%,and 88.0%and 66.1%for control group,respectively,with no statistical difference between the two groups in overall survival(P=0.499).After PSM,the 1-and 3-year overall survival rates of the HIPEC group were 86.8%and 69.7%,and 93.1%and 67.5%for control group,respectively,with no statistical difference between the two groups in overall survival(P=0.425).Before PSM,the 1-and 3-year disease-free survival rates of the HIPEC group were 88.2%and 67.1%,and 87.8%and 64.3%for control group,respectively,with no statistical difference between the two groups in disease-free survival(P=0.863).After PSM,the 1-and 3-year disease-free survival rates of the HIPEC group were 88.2%and 62.8%,and 93.7%and 64.7%for control group,respectively,with no statistical difference between the two groups in disease-free survival(P=0.804).Conclusions Radical surgery combined with HIPEC for elderly patients with gastric cancer does not increase postoperative complications and postoperative recovery time.However,there was no significant difference in overall survival and disease-specific survival between the two groups.