胃癌腹膜转移的临床治疗进展与未来展望

Recent progress and future prospects of treatment for peritoneal metastasis in gastric cancer

腹膜转移是胃癌最常见的转移形式之一,也是临床诊治的难点。当前,胃癌腹膜转移的治疗仍以全身系统化疗为主。对于经过筛选的患者,肿瘤细胞减灭术、腹腔热灌注化疗和新辅助腹腔内联合全身化疗等新疗法的合理组合应用,将给患者带来显著的生存获益。对于尚无明确腹膜转移、但存在高危因素的患者,进行预防性治疗,可降低腹膜复发的风险,进而提高生存率。但具体方案的选择还需高质量的随机对照试验来验证。术中广泛腹腔灌洗作为预防性措施的效用并没有得到临床研究的证实,术中腹腔热灌注化疗的安全性也需要进一步评估。腹腔热灌注化疗与新辅助腹腔内联合全身化疗在转化治疗中取得了较好的效果,需要寻找更高效低毒的转化治疗模式、筛选出潜在获益的人群。肿瘤细胞减灭术联合腹腔热灌注化疗对胃癌腹膜转移的效用已得到了初步的验证,随着PERISCOPEⅡ等临床研究的完成,将带来更多的证据。

Peritoneal metastasis is one of the most frequent patterns of metastasis in gastric cancer,and remains a major unmet clinical problem.Thus,systemic chemotherapy remains the mainstay of treatment for gastric cancer with peritoneal metastasis.In well-selected patients,the reasonable combination of cytoreductive surgery,hyperthermic intraperitoneal chemotherapy(HIPEC),and neoadjuvant intraperitoneal chemotherapy with systemic chemotherapy will bring significant survival benefits to patients with gastric cancer peritoneal metastasis.In patients with high-risk factors,prophylactic therapy may reduce the risk of peritoneal recurrence,and improves survival after radical gastrectomy.However,high-quality randomized controlled trials will be needed to determine which modality is better.The safety and efficacy of intraoperative extensive intraperitoneal lavage as a preventive measure has not been proven.The safety of HIPEC also requires further evaluation.HIPEC and neoadjuvant intraperitoneal and systemic chemotherapy have achieved good results in conversion therapy,and it is necessary to find more efficient and low-toxicity therapeutic modalities and screen out the potential benefit population.The efficacy of CRS combined with HIPEC on peritoneal metastasis in gastric cancer has been preliminarily validated,and with the completion of clinical studies such as PERISCOPE II,more evidence will be available.