细胞减灭术加腹腔热灌注化疗治疗胃癌腹膜转移癌的临床研究

目的:分析细胞减灭术(Cytoreductive surgery,CRS)加腹腔热灌注化疗(Hyperthermic intraperitoneal chemotherapy,HIPEC)治疗胃癌腹膜癌(Peritoneal carcinomatosis,PC)的疗效和安全性。方法:对106例胃癌PC患者随机分为CRS组或CRS+HIPEC组,前者行常规手术治疗,后者行CRS+HIPEC,药物为羟基喜素碱(HTPC)20 mg加丝裂霉素(MMC)30 mg,或多西他赛120mg加顺铂120mg,溶于生理盐水12 L,温度(43±0.5)℃,时间60～90min。主要终点指标为总体生存期,次要终点指标为安全性。结果:入组患者106例,CRS组45例,CRS+HIPEC组61例,两组的主要临床病理指标平衡。至患者的中位随访期30个月时,胃癌PC相关死亡率在CRS组为93.3%(42/45),CRS+HIPEC组为77.0%(47/61,P<0.05)。两组患者的中位生存期在CRS组是7.0个月(95%CI:5.8～8.2个月),CRS+HIPEC组是11.1个月(95%CI:8.3～13.9个月,P=0.003)。治疗相关的严重不良事件在CRS组为6例,CRS+HIPEC组为8例(P>0.05)。多因素分析显示CRS+HIPEC治疗、胃癌同时性PC患者、肉眼可见完全肿瘤细胞减灭、不发生严重不良事件、系统性化疗6个周期以上为影响预后的独立参数。结论:对于胃癌同时性PC患者,CRS+HIPEC可延长生存期,并不明显增加严重不良事件。

新型阿霉素前体药PADM治疗胃癌腹膜转移癌

目的观察PADM（Ac-Phe—Lys—PABC—ADM）对SGC-7901胃癌腹膜癌模型的疗效及不良反应。方法将人SGC-7901胃癌组织匀浆注入BALB／C裸小鼠腹腔，建立胃癌腹膜转移癌模型，随机分为对照组（n=9，每4d腹腔注射生理盐水10ml／kg）、阿霉素（ADM）组（n=10，每4d腹腔注射ADM2mg／kg）、PADM组（n=10，每4d腹腔注射PADM7．2mg／kg）。检测动物体质量、实验性腹膜转移癌指数（ePCI）评分、血常规、血生化指标，评估PADM疗效和不良反应。结果PADM组和ADM组ePCI评分分别为1．0（1—4）和1．5（0—6），均显著低于对照组ePCI6．0（1～10）（P〈0．01）。与对照组体质量（24．32±1．40）g比较，PADM组体质量（23．61±0.80）g无显著下降，ADM组体质量（18．40±2．97）g明显下降（P〈0．01）。PADM对骨髓、心、肝等不良反应均有明显减轻，尤其是心脏不良反应，而ADM则表现明显心脏不良反应。结论PADM能够显著抑制胃癌腹膜转移癌形成，显著降低心、肝、骨髓等不良反应。

Peritoneal lavage cytology and carcinoembryonic antigen determination in predicting peritoneal metastasis and prognosis of gastric cancer

AIM: To evaluate the role of peritoneal lavage cytology (PLC) and carcinoembryonic antigen (CEA) determination of peritoneal washes (pCEA) in predicting the peritoneal metastasis and prognosis after curative resection of gastric cancer.METHODS: PLC and radioimmunoassay of CEA were performed in peritoneal washes from 64 patients with gastric cancer and 8 patients with benign diseases.RESULTS: The positive rate of pCEA (40.6%) was significantly higher than that of PLC (23.4%) (P<0.05).The positive rates of PLC and pCEA correlated with the depth of tumor invasion and lymph node metastasis (P<0.05). pCEA was found to have a higher sensitivity and a lower false-positive rate in predicting peritoneal metastasis after curative resection of gastric cancer as compared to PLC. The 1-, 3-, and 5-year survival rates of patients with positive cytologic findings or positive pCEA results were significantly lower than those of patients with negative cytologic findings or negative pCEA results (P<0.05). Multivariate analysis indicated that pCEA was an independent prognostic factor for the survival of patients with gastric cancer.CONCLUSION: Intraoperative pCEA is a more sensitive and reliable predictor of peritoneal metastasis as well as prognosis in patients with gastric cancer as compared to PLC method.