预防性腹腔热灌注化疗对局部进展期胃癌根治术后病人预后改善的有效性研究

doi:10.16139/j.1007-9610.2023.04.013

摘要/Abstract

摘要：

目的：探讨术后预防性腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）对临床分期为cT_3-4N_xM₀的局部进展期胃癌病人的临床治疗价值。方法：回顾性收集分析2016年1月至2021年12月我院普通外科收治的60例接受D2根治术局部进展期（cT_3-4N_xM₀）胃癌病人的临床资料。将接受预防性HIPEC的病人纳入HIPEC组（n=30），未接受预防性HIPEC的病人纳入对照组（n=30），两组病人均进行术后常规辅助系统化疗。通过随访比较两组病人的中位生存时间和总生存率，分析影响总生存率的危险因素。结果：HIPEC组的中位生存时间51.0个月（95% CI: 40.7~61.3），高于对照组的30.0个月（95% CI: 16.3~43.7）。HIPEC组的3年和5年总生存率(66.7%、53.3%)均高于对照组（56.7%、43.3%）（P=0.019）。预防性HIPEC是影响局部进展期胃癌术后病人预后的保护因素（P=0.021）。结论：对于cT_3-4N_xM₀局部进展期胃癌病人，预防性HIPEC能够延长病人根治术后的中位生存时间，提高总生存率。

关键词: 胃癌, 腹腔热灌注化疗, 局部进展期, 腹膜转移, 生存分析

Abstract:

Objective To explore the efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for locally advanced gastric cancer with clinical stage cT_3-4N_xM₀. Methods A retrospective collection and analysis of clinical data was conducted from 60 patients with locally advanced gastric cancer (cT_3-4N_xM₀) who underwent D2 radical surgery between January 2016 and December 2021 at our department. Patients who underwent prophylactic HIPEC were classified into the HIPEC group (n=30), while patients who did not undergo prophylactic HIPEC were clssified into the control group (n=30). Both groups of patients routinely were treated with postoperative adjuvant systemic chemotherapy. The median survival time, and overall survival rate of the two groups were compared through follow-up, and the risk factors affecting the overall survival rate were analyzed. Results The median survival time of the HIPEC group was 51.0 months (95% CI: 40.7-61.3), which was higher than that of the control group with 30.0 months (95% CI: 16.3-43.7). The 3-year and 5-year overall survival rates of the HIPEC group (66.7%, 53.3%)were higher than those of the control group（56.7%, 43.3%） (P=0.019). Prophylactic HIPEC was the protective factor affecting the overall survival rate of postoperative patients with locally advanced gastric cancer (P=0.021). Conclusions For patients with locally advanced cT_3-4N_xM₀ gastric cancer, prophylactic HIPEC plays an important role in prolonging the median survival time, hence impro-ving the overall survival rate of patients.

Key words: Gastric cancer, Hyperthermic intraperitoneal chemotherapy, Locally advanced stage, Peritoneal metastasis, Survival analysis

中图分类号:

R735.2

孙祺, 黄文博, 何炳良, 刘畅, 徐宇航, 赵伟. 预防性腹腔热灌注化疗对局部进展期胃癌根治术后病人预后改善的有效性研究[J]. 外科理论与实践, 2023, 28(04): 366-370.

SUN Qi, HUANG Wenbo, HE Bingliang, LIU Chang, XU Yuhang, ZHAO Wei. Efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy for locally advanced gastric cancer[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 366-370.

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Clinicopathological characteristics	Control group （n=30）	HIPEC group （n=30）	t/χ²	P value
Gender			1.491	0.222
Male	21	25
Female	9	5
Age（year）	61.0 ± 9.9	55.0 ± 13.6	1.842	0.071
cT staging			5.963	0.015
cT₃	11（36.7）	3（10.0）
cT₄	19（63.3）	27（90.0）
pT staging			7.500	0.006
pT₃	15（50.0）	5（16.7）
pT₄	15（50.0）	25（83.3）
pN staging			5.186	0.159
pN₀	7（23.3）	6（20.0）
pN₁	7（23.3）	3（10.0）
pN₂	9（30.0）	6（20.0）
pN₃	7（23.3）	15（50.0）
Gastrectomy type			1.273	0.529
Total	15（50.0）	18（60.0）
Distal	14（46.7）	10（33.3）
Proximal	1（3.3）	2（6.7）
Pathological classification			0.351	0.554
Adenocarcinoma	29（96.7）	28（93.3）
Neuroendocrine carcinoma	1（3.3）	2（6.7）
Histological grading			1.328	0.722
Poorly	15（50.0）	18（60.0）
Moderately	5（16.7）	4（13.3）
Moderately-poorly	9（30.0）	6（20.0）
Others	1（3.3）	2（6.7）

Clinicopathological characteristics	Multivariable COX regression
Clinicopathological characteristics	HR（95% CI）	P value
Age
>60 vs. ≤60	1.165（0.523-2.592）	0.709
Gender
Female vs. male	1.031 （0.386-2.757）	0.951
pN staging
pN+ vs. pN₀	1.814 （0.600-5.487）	0.292
Prophylactic HIPEC
HIPEC vs. non-HIPEC	0.406（0.188-0.875）	0.021
Pathological classification
Adenocarcinoma vs. neuroendocrine carcinoma	0.386（0.015-9.952）	0.566
Histological grading
Moderately vs. poorly	0.752（0.231-2.447）	0.636
Moderately-poorly vs. poorly	0.901（0.325-2.493）	0.841
Others vs. poorly	0.479（0.046-4.967）	0.537
Gastrectomy type
Distal vs. total	2.225（0.800-6.187）	0.125
Proximal vs. total	1.246（0.298-5.208）	0.763

	Control group	HIPEC group	P value
Anastomotic leakage
Wound infection	2	1
Lung infection		1
Thrombus of lower extremity veins		1
Gastro-intestinal bleeding	1
Ileus	1
Renal dysfunction
Sum	4	3	1.000