腹腔热灌注化疗治疗胃癌腹膜转移的安全性及有效性单中心临床研究

The single-center clinical analysis of efficacy and safety in hyperthermic intraperitoneal chemo-therapy for gastric cancer patients with peritoneal metastasis

目的探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗胃癌腹膜转移(gastric cancer of peritoneal carcinomatosis,GCPC)的安全性和有效性。方法 2016年6月~2019年1月我院收治的GCPC病人67例,根据治疗方式不同分为两组,HIPEC组46例,于术后行HIPEC治疗;非HIPEC组21例,术后未行HIPEC治疗。比较两组病人的治疗相关并发症和生存数据,分析影响GCPC病人预后的相关因素。结果 HIPEC治疗对病人的术后血象指标和术后并发症均无显著改变。联合肿瘤细胞减灭术(cytoreductive surgery,CRS)和HIPEC治疗的病人,中位生存期优于仅行CRS治疗者(14个月vs 9个月,P=0.012)。多因素分析提示,术后早期行HIPEC治疗及术后行全身静脉化疗和(或)放疗能为完成肿瘤细胞减灭术的GCPC病人带来生存获益,术前血清CA724升高是预后的独立危险因素。结论对于实现肉眼可见完全肿瘤细胞减灭的胃癌腹膜转移病人,CRS+HIPEC的治疗策略并不会增加治疗相关并发症的发生,同时能够延长病人生存期。

Objective To evaluate the clinical efficacy and safety of hyperthermic intraperitoneal chemotherapy,HIPEC in the treatment of gastric cancer with peritoneal carcinomatosis,GCPC.Methods The clinical data of 67 patients with GCPC who were treated by surgery and confirmed by pathology were retrospectively analyzed.Among them,46 patients undergo HIPEC treatment,the other 21 patients refuse HIPEC treatment.Treatment-related complications and postoperative survival data were compared to ana-lyze the factors involved in the prognosis of GCPC patients.Results There was no significant difference with respect to treatment-related serious adverse event,SAE.Patients who received CRS CCR(0~1)(n=24)and HIPEC(n=15)at the same time had a median OS of 14 months,while those who receive CRS a-lone(n=9)had a median OS of 6 months(P=0.012).Multivariate analysis suggested that early HIPEC treatment and regular postoperative chemotherapy bring survival benefit for GCPC patients who underwent CRS CCR(0~1),the elevation of serum CA724 were independent risk factor to postoperative survival time of GCPC.Conclusion For patients with peritoneal metastasis of gastric cancer who achieve complete tumor cell extinction visible to the naked eye,the treatment strategy of CRS+HIPEC will not increase the occurrence of treatation-related complications,and at the same time can prolong the survival of patients.