腹腔热灌注化疗治疗不同Borrmann分型进展期胃癌的临床效果及对肿瘤标志物的影响

The effect ofintraperitoneal hyperthermic perfusion chemotherapy on different Borrmann classification of advanced gastric cancer and the effect of serum tumor markers

目的探讨腹腔热灌注化疗(HIPEC)对于不同Borrmann分型进展期胃癌的疗效及对血清肿瘤标志物的影响。方法回顾性分析上海中医药大学附属曙光医院2011年1月至2016年1月收治的165例行腹腔镜下胃癌根治术患者的临床资料,将术后行常规静脉化疗的82例患者为对照组,行静脉化疗联合HIPEC的83例患者为观察组,比较两组患者的近期临床疗效,治疗前后血清肿瘤标志物[糖类抗原72-4(CA72-4)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)]水平变化情况,不良反应及并发症发生情况以及术后5年复发转移及生存情况。结果治疗后,观察组患者的疾病控制率及治疗有效率均高于对照组,差异具有统计学意义(P<0.05),治疗期间两组患者病死率差异无统计学意义(P>0.05)。两组患者不良反应及并发症发生率差异无统计学意义(P>0.05)。对于BorrmannⅠ型、Ⅱ型患者,两组复发转移率及5年生存率差异无统计学意义(P>0.05);对于BorrmannⅢ型、Ⅳ型患者,观察组的复发转移率低于对照组,5年生存率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者CA72-4、CA19-9、CEA水平差异无统计学意义(P>0.05),治疗后,两组患者CA72-4、CA19-9、CEA水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论对进展期胃癌患者行胃癌根治术联合HIPEC治疗,可提高BorrmannⅢ、Ⅳ型患者的5年生存率,降低5年内复发率,降低血清肿瘤标志物水平,且并发症及不良反应的发生率未增加,安全性较高。

Objective To investigate the effect of intraperitoneal hyperthermic perfusion chemotherapy(HIPEC) on different Borrmann types of advanced gastric cancer and the effect of serum tumor markers. Methods A total of 165 patients with Ⅲ stage B gastric cancer admitted to Shuguang Hospital of Shanghai University of Traditional Chinese Medicine from January 2011 to January 2016 were selected, all of them underwent laparoscopic radical gastrectomy. The patients who received conventional intravenous chemotherapy after surgery were divided into control group(82 cases), and the patients who received intravenous chemotherapy combined with HIPEC were divided into observation group(83 cases). The short-term clinical efficacy, changes in serum tumor markers(carbohydrate antigen 72-4 [CA72-4], carbohydrate antigen 19-9 [CA19-9], carcinoembryonic antigen [CEA]) levels before and after treatment, the incidence of adverse reactions and complications, recurrence and metastasis and survival 5 years after surgery were compared between two groups. Results After treatment, the disease control rate and effective rate in the observation group were higher than those in the control group, the differences were statistically significant(P<0.05), and there was no statistically significant difference in the mortality rate between the two groups during treatment(P>0.05). There were no statistical significance in the incidence of adverse reactions and complications between 2 groups(P>0.05). For patients with Borrmann Ⅰ type and normal type, there were no statistically significant difference in the recurrence and metastasis rate and 5-year survival rate(P>0.05). For patients with Borrmann Cor type and normal type, the recurrence and metastasis rate in the observation group was lower than that in the control group, and the 5-year survival rate was higher than that in the control group, the difference was statistically significant(P<0.05). Before treatment, CA72-4, CA19-9 and CEA levels in 2 groups had no statistical significance(P>0.05), after treatment, CA72-4, CA19-9 and CEA levels in 2 groups were lower than before treatment, and the observation group was lower than the control group, the difference was statistically significant(P<0.05). Conclusions HIPEC treatment for patients with advanced gastric cancer after radical gastric cancer can improve the 5-year survival rate of Borrmann type Ⅲ and Ⅳ patients, reduce the recurrence rate within 5 years, and reduce the serum tumor marker levels without increasing complications and adverse reactions.