洛铂术中单次灌洗化疗联合术后腹腔洛铂热灌注化疗对T4胃癌的疗效对比研究

A comparative study of the therapeutic efficacy of intraoperative single lavage chemotherapy versus combined postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin in patients with t4 gastric cancer

目的研究洛铂术中腹腔单次灌洗化疗联合术后腹腔洛铂热灌注化疗对T4期胃癌行根治术后联合治疗的有效性和安全性。方法回顾性分析了2018年9月至2020年9月于中国医学科学院肿瘤医院、北京市朝阳区桓兴肿瘤医院行胃癌切除术加术中腹腔洛铂单次灌洗化疗的72例T4期胃癌患者的临床资料,根据是否进行术后腹腔洛铂热灌注化疗将患者分为两组,其中术中腹腔洛铂单次灌洗化疗联合术后腹腔洛铂热灌注化疗为研究组36例,仅术中腹腔单纯洛铂单次灌洗化疗为对照组36例。比较两组的基线资料,围手术期资料,包括中转开腹率、手术时间、术中失血、住院时间、术后30 d死亡率、排气时间、恢复经口进食时间,术后并发症发生率,血液学指标变化情况及术后腹膜复发情况等,比较两组患者的3年总生存率及无病生存率。结果两组患者术后并发症发生率差异无统计学意义(P>0.05)。两组均记录有轻度的血小板减少和白细胞减少(χ^(2)=0.167,P=0.683),肾功能异常(χ^(2)=0,P=1)、肝功能异常(χ^(2)=0.278,P=0.599),但差异无统计学意义。两组平均随访时间为35.1个月,单纯术中腹腔洛铂灌洗与术后联合腹腔洛铂热灌注在腹膜转移复发方面差异具有统计学意义(χ^(2)=3.611,P=0.046)。两组患者的3年总生存率(P=0.764)及3年无病生存率(P=0.911)差异无统计学意义。结论术后单次腹腔洛铂灌洗化疗和联合术后腹腔洛铂热灌注化疗在T4胃癌患者中是安全可行的。术中洛铂灌洗化疗联合术后腹腔洛铂热灌注化疗可以降低术后腹膜复发的风险。

Objective This study aimed to assess the effectiveness and safety of intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal hyperthermic perfusion chemotherapy using lobaplatin in the treatment of T4 stage gastric cancer following radical surgery.Methods A retrospective analysis was conducted on clinical data of 72 T4 stage gastric cancer patients who underwent gastrectomy with intraoperative intraperitoneal chemotherapy from September 2018 to September 2020 at the Cancer Hospital of the Chinese Academy of Medical Sciences and Huanxing Cancer Hospital.Patients were divided into two groups based on whether postoperative hyperthermic chemotherapy was performed.The study group included 36 cases with intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin,and the control group comprised 36 cases with intraoperative intraperitoneal lobaplatin chemotherapy alone.Baseline data and perioperative information,including conversion rate of laparotomy,operation time,intraoperative blood loss,hospital stay,30-day postoperative mortality,time to passage of flatus,time to resume oral intake,postoperative complication rate,changes of hematological indexes and peritoneal recurrence,were compared between the two groups.Survival analysis was conducted to compare total survival rates and disease-free survival rates.Results There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Both groups showed mild thrombocytopenia and leukopenia(χ^(2)=0.167,P=0.683),abnormal renal function(χ^(2)=0,P=1),and abnormal liver function(χ^(2)=0.278,P=0.599),but the difference was not statistically significant.The average follow-up time was 35.1 months.In comparison,postoperative intraperitoneal lobaplatin lavage demonstrated a statistically significant difference in peritoneal recurrence compared to combined postoperative intraperitoneal hyperthermic lobaplatin chemotherapy(χ^(2)=3.611,P=0.046).The 3-year overall survival rate(P=0.764)and 3-year disease-free survival rate(P=0.911)were not significantly different in both groups.Conclusions Postoperative single intraperitoneal chemotherapy and combined postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin are safe and feasible in T4 gastric cancer patients.Postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin can reduce the risk of peritoneal metastasis.