肿瘤细胞减灭术加腹腔热灌注化疗治疗110例胃癌腹膜癌临床分析

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy to treat peritoneal carcinomatosis from gastric cancer： a clinical study of 110 patients

目的胃癌腹膜癌（GCPC）预后极差，尚无标准治疗。本研究观察细胞减灭术（CRS）加腹腔热灌注化疗（CRS＋HIPEC）治疗GCPC的安全性和疗效。方法收集2005年3月至2017年6月间北京世纪坛医院腹膜肿瘤外科CRS＋HIPEC综合诊治GCPC患者110例的临床资料及随访信息[中位年龄为50（23～74岁），男52例（47.3%），女58例（52.7%）]，进行多因素分析，主要终点是生存率，次要终点是安全性。结果110例GCPC患者接受CRS＋HIPEC治疗，中位生存期为13.1个月，1、2、3、5年生存率分别为：56.4%、24.9%、11.2%、7.8%。围手术期死亡率为0.9%，严重不良事件率为8.2%。单因素分析显示，性别、术前肿瘤标志物[癌胚抗原（CEA）、CA125、CA199]、PC时相、手术时间、术后辅助化疗、腹膜癌指数、细胞减灭程度、HIPEC温度、腹水量对预后有显著影响。多因素分析显示，细胞减灭程度、腹水量、术后辅助化疗为独立预后因子。结论CRS＋HIPEC可延长部分GCPC患者生存期，尤其是术前肿瘤标志物正常、腹膜癌指数低、无腹水、同时性区域播散形成腹膜癌（PC）患者。严格的病例筛选和彻底的CRS是该治疗策略成功的关键。

ObjectiveTo evaluate the safety and efficacy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy （CRS＋ HIPEC） in patients with peritoneal carcinomatosis from gastric cancer （GCPC）.MethodsThe clinical data and follow-up results of GCPC patients treated with CRS＋ HIPEC were collected for a retrospective analysis. The primary endpoint was survival rate and the secondary endpoint was safety.ResultsA total of 110 GCPC patients accepted CRS＋ HIPEC, with a median overall survival （OS） of 13.1 months, and with 1-, 2-, 3-, and 5-year survival rates of 56.4%, 24.9%, 11.2%, and 7.8%, respectively. The perioperative mortality was 0.9%, and the morbidity of serious adverse events was 8.2%. Univariate analysis showed that gender, tumor marker before surgery, PC type, length of surgery, postoperative adjuvant chemotherapy, peritoneal cancer index （PCI）, completeness of cytoreduction, HIPEC temperature, and ascites had a significant impact on OS. Multivariate Cox-analysis showed that completeness of cytoreduction, ascites, and postoperative adjuvant chemotherapy were independent factors of OS.ConclusionCRS＋ HIPEC improves survival for GCPC patients with normal preoperative tumor markers, low PCI, no ascites and synchronous PC. Stringent patient selection and complete CRS are two key factors for better survival.