细胞减灭术加腹腔热灌注化疗治疗胃癌腹膜癌

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer with Ascites and/or Peritoneal Carcinomatosis

目的:评估细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)治疗胃癌腹膜转移癌(伴/不伴恶性腹水)的疗效及安全性。方法:28例进展期胃癌腹膜转移癌患者接受CRS加HIPEC治疗,主要研究指标为生存期,次要指标为围手术期安全性及不良事件。结果:28例患者共接受30次CRS加HIPEC治疗。术中评估腹膜癌指数2-31(中位数12)。细胞减灭程度0分者11例(39.2%),1分6例(21.4%),2分8例(28.8%),3分3例(10.6%)。截至2010年5月1日,随访期5-57月(中位数24月),19例(67.9%)死亡,9例(32.1%)存活。6,12,18和24月的生存率分别为75%,50%,43%和43%。PCI≤20和>20者中位生存期分别为27.7月(95%CI,15.2-40.3月)和6.4月(95%CI,3.8-8.9月)(P=0.000)。CCR-0、CCR-1、CCR-2&3中位生存期为43.4月(95%CI,26.9-59.9月)、9.4月(95%CI,7.4-11.4月)和8.3月(95%CI,3.0-13.6月)(P=0.001)。同时性和异时性腹膜转移癌者中位生存期分别为24月(95%CI,21.6-48.4月)和12月(95%CI,6.6-19.4月)(P=0.000)。无术后30d内死亡病例,围手术期严重不良事件4例(肠梗阻2例、成人呼吸窘迫综合征1例、胆漏1例)。结论:细胞减灭术加腹腔热灌注化疗使胃癌腹膜癌患者受益,延长生存期。

Objective：To evaluate cytoreductive surgery（CRS）plus hyperthermic intraperitoneal chemotherapy（HIPEC）in the treatment of advanced gastric cancer（GC）with peritoneal carcinomatosis and/or ascites.Methods：CRS and HIPEC procedures were performed in 28GC patients with peritoneal carcinomatosis and/or malignant ascites,with survival and perioperative safety as study endpoints.Results：A total of 30CRS and HIPEC procedures were performed.Cytoreduction scores ratings were CCR-0 in 11（39.2%）,CCR-1 in 6（21.4%）,CCR-2in 8（28.8%）,and CCR-3 in 3（10.6%）cases.19 patients（67.9%）were dead and 9 patients（32.1%）survived, and the 6-,12-,18-and 24-month survival rates were 75%,50%,43%,and 43%,respectively.The median survivals of patients with peritoneal carcinomatosis index（PCI）≤20 and PCI20 were 27.7months（95%CI=15.2-40.3 months）and 6.4 months（95%CI=3.8-8.9 months） （P=0.000）respectively.The estimated median survival for patients with CCR-0,CCR-1 and CCR-23were 43.4months（95%CI=26.9-59.9 months）,9.5months（95%CI=6.4-12.6 months）,and 7.5months（95% CI=3.0-13.6 months）respectively（P=0.001,CCR0vs CCR1-3）.The median survivals of patients with synchronous and metachronous peritoneal carci-nomatosis were 24 months（95%CI=21.6-48.4months）and 12 months（95%CI=6.6-19.4 months）respectively（P=0.000）.No perioperative death but 4（14.3%）serious adverse events occurred.Conclusion：CRS plus HIPEC could offer survival advantage for selected GC patients with peritoneal carcinomatosis and ascites,with acceptable safety profile.