外科理论与实践 ›› 2021, Vol. 26 ›› Issue (01): 11-16.doi: 10.16139/j.1007-9610.2021.01.003
姬忠贺a, 李雁a,b(
)
收稿日期:2020-12-10
出版日期:2021-01-25
发布日期:2022-07-28
通讯作者:
李雁
E-mail:liyansd2@163.com
基金资助:
JI Zhonghea, LI Yana,b()
Received:2020-12-10
Online:2021-01-25
Published:2022-07-28
中图分类号:
姬忠贺, 李雁. 肿瘤细胞减灭术加腹腔热灌注化疗治疗胃癌腹膜转移的现状与前景[J]. 外科理论与实践, 2021, 26(01): 11-16.
JI Zhonghe, LI Yan. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in treatment of peritoneal metastatic gastric cancer: current status and future prospects[J]. Journal of Surgery Concepts & Practice, 2021, 26(01): 11-16.
表1
CRS+HIPEC治疗胃癌腹膜转移生存数据
| 作者 | n | 中位生存期（月） | 生存率（%） | ||
|---|---|---|---|---|---|
| 1年 | 3年 | 5年 | |||
| Bonnot等[ | 180 | 18.8 | / | 26.2 | 19.9 |
| Yonemura等[ | 83 | / | 43.0 | / | 11.0 |
| Fujimoto等[ | 48 | 14.1 | 54.0 | 41.5 | 31.0 |
| Hall等[ | 34 | 8.0 | 27.0 | / | 6.0 |
| Glehen等[ | 49 | 10.3 | 48.1 | / | 16.0 |
| Yonemura等[ | 107 | 11.5 | / | / | 6.7 |
| Glehen等[ | 159 | 9.2 | 43.0 | 18.0 | 13.0 |
| Canbay等[ | 194 | 15.8 | 66.0 | / | 10.7 |
| Desantis等[ | 14 | 13.3 | / | 21.6 | 21.6 |
| Boerner等[ | 38 | 17.2 | 71.1 | 24.1 | 6.4 |
| Passot等[ | 127 | 13.0 | / | / | 14.0 |
| Rihuete Caro等[ | 35 | 16.0 | 70.8 | 21.3 | 21.3 |
| Manzanedo等[ | 88 | 21.2 | 79.9 | 30.9 | 27.5 |
| 姬忠贺等[ | 115 | 13.1 | 56.5 | 12.6 | 8.1 |
| Yonemura等[ | 419 | / | / | / | 9.6 |
图1
PCI和CC示意图 A：PCI示意图;B：CC示意图。PCI用于评估腹膜转移程度,将腹部分成13个区,腹部九分法9个区,以及空肠上段、空肠下段、回肠上段、回肠下段4个区。对每个区的肿瘤负荷评分：0分为肉眼未见癌组织,1分为癌组织直径≤0.5 cm,2分为>0.5 cm至5.0 cm, 3分为>5 cm或融合,总分39分。CC评分用于评估CRS程度：CC-0分为CRS术后无残余肿瘤;CC-1分为残余肿瘤直径<0.25 cm;CC-2分为0.25~2.50 cm;CC-3分为>2.50 cm,残留无法切除或姑息切除的病灶;CC-0为完全CRS,CC-1、CC-2、CC-3为不完全CRS
图2
CRS+HIPEC治疗胃癌腹膜转移的病例筛选策略 注：根据腹膜转移时相和术前肿瘤标志物（癌胚抗原、糖类抗原125、糖类抗原199）情况,将胃癌腹膜转移分为4个亚组：①同时性且术前肿瘤标志物正常;②同时性且术前肿瘤标志物异常;③异时性且术前肿瘤标志物正常;④异时性且术前肿瘤标志物异常,其适合CRS+HIPEC治疗的PCI分别为≤16、≤12、≤10、≤5
图3
针对胃癌腹膜转移HIPEC治疗相关注册研究年度分布及地域分布
| [1] | 姬忠贺, 李鑫宝, 于洋, 等. 开拓临床肿瘤实践前沿创建腹膜肿瘤学科[J]. 中国肿瘤临床, 2020, 47(3):110-113. |
| [2] |
Spratt JS, Adcock RA, Muskovin M, et al. Clinical delive-ry system for intraperitoneal hyperthermic chemotherapy[J]. Cancer Res, 1980, 40(2):256-260.
pmid: 6766084 |
| [3] |
Sugarbaker PH. Peritonectomy procedures[J]. Ann Surg, 1995, 221(1):29-42.
pmid: 7826158 |
| [4] |
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis[J]. Cancer Treat Res, 1996, 82:359-374.
pmid: 8849962 |
| [5] |
Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutio-nal study[J]. J Clin Oncol, 2004, 22(16):3284-3292.
pmid: 15310771 |
| [6] | Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase Ⅲ randomized clinical trial[J]. Ann Surg Oncol, 2011, 18(6):1575-1581. |
| [7] | van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer[J]. N Engl J Med, 2018, 378(3):230-240. |
| [8] |
Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study[J]. Cancer, 2000, 88(2):358-363.
pmid: 10640968 |
| [9] |
Thomassen I, van Gestel YR, van Ramshorst B, et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival and risk factors[J]. Int J Cancer, 2014, 134(3):622-628.
doi: 10.1002/ijc.28373 pmid: 23832847 |
| [10] | Ji ZH, Peng KW, Yu Y, et al. Current status and future prospects of clinical trials on CRS + HIPEC for gastric cancer peritoneal metastases[J]. Int J Hyperthermia, 2017, 33(5):562-570. |
| [11] |
Desiderio J, Chao J, Melstrom L, et al. The 30-year experience-A meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer[J]. Eur J Cancer, 2017, 79:1-14.
doi: S0959-8049(17)30868-7 pmid: 28456089 |
| [12] | Bonnot PE, Piessen G, Kepenekian V, et al. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): a propensity score analysis[J]. J Clin Oncol, 2019, 37(23):2028-2040. |
| [13] | Hong SH, Shin YR, Roh SY, et al. Treatment outcomes of systemic chemotherapy for peritoneal carcinomatosis arising from gastric cancer with no measurable disease: retrospective analysis from a single center[J]. Gastric Cancer, 2013, 16(3):290-300. |
| [14] | Yonemura Y, Fujimura T, Nishimura G, et al. Effects of intraoperative chemohyperthermia in patients with gastric cancer with peritoneal dissemination[J]. Surgery, 1996, 119(4):437-444. |
| [15] |
Fujimoto S, Takahashi M, Mutou T, et al. Improved mortality rate of gastric carcinoma patients with peritoneal carcinomatosis treated with intraperitoneal hyperthermic chemoperfusion combined with surgery[J]. Cancer, 1997, 79(5):884-891.
pmid: 9041149 |
| [16] | Hall JJ, Loggie BW, Shen P, et al. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer[J]. J Gastrointest Surg, 2004, 8(4):454-463. |
| [17] | Glehen O, Schreiber V, Cotte E, et al. Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer[J]. Arch Surg, 2004, 139(1):20-26. |
| [18] | Yonemura Y, Kawamura T, Bandou E, et al. Treatment of peritoneal dissemination from gastric cancer by peritonectomy and chemohyperthermic peritoneal perfusion[J]. Br J Surg, 2005, 92(3):370-375. |
| [19] | Glehen O, Gilly FN, Arvieux C, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy[J]. Ann Surg Oncol, 2010, 17(9):2370-2377. |
| [20] |
Canbay E, Mizumoto A, Ichinose M, et al. Outcome data of patients with peritoneal carcinomatosis from gastric origin treated by a strategy of bidirectional chemotherapy prior to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a single specialized center in Japan[J]. Ann Surg Oncol, 2014, 21(4):1147-1152.
doi: 10.1245/s10434-013-3443-2 pmid: 24356799 |
| [21] | Desantis M, Bernard JL, Casanova V, et al. Morbidity, mortality, and oncological outcomes of 401 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC)[J]. Langenbecks Arch Surg, 2015, 400(1):37-48. |
| [22] |
Boerner T, Graichen A, Jeiter T, et al. CRS-HIPEC prolongs survival but is not curative for patients with peritoneal carcinomatosis of gastric cancer[J]. Ann Surg Oncol, 2016, 23(12):3972-3977.
pmid: 27313067 |
| [23] | Passot G, Vaudoyer D, Villeneuve L, et al. What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: a 25-year experience with 1,125 procedures[J]. J Surg Oncol, 2016, 113(7):796-803. |
| [24] | Rihuete Caro C, Manzanedo I, Pereira F, et al. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with gastric cancer and peritoneal carcinomatosis[J]. Eur J Surg Oncol, 2018, 44(11):1805-1810. |
| [25] |
Manzanedo I, Pereira F, Rihuete Caro C, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer with peritoneal carcinomatosis: multicenter study of Spanish Group of Peritoneal Oncologic Surgery (GECOP)[J]. Ann Surg Oncol, 2019, 26(8):2615-2621.
doi: 10.1245/s10434-019-07450-4 pmid: 31115852 |
| [26] | 姬忠贺, 于洋, 刘刚, 等. 肿瘤细胞减灭术加腹腔热灌注化疗治疗胃癌腹膜转移的预后列线图构建与验证[J]. 中华普通外科杂志, 2019, 34(10):833-836. |
| [27] | Yonemura Y, Prabhu A, Sako S, et al. Long term survival after cytoreductive surgery combined with perioperative chemotherapy in gastric cancer patients with peritoneal metastasis[J]. Cancers (Basel), 2020, 12(1):116. |
| [28] | Chicago Consensus Working Group. The Chicago Consensus on peritoneal surface malignancies: management of gastric metastases[J]. Cancer, 2020, 126(11):2541-2546. |
| [29] |
Coccolini F, Cotte E, Glehen O, et al. Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials[J]. Eur J Surg Oncol, 2014, 40(1):12-26.
doi: 10.1016/j.ejso.2013.10.019 pmid: 24290371 |
| [30] | 姬忠贺, 刘刚, 安松林, 等. 完全肿瘤细胞减灭术加腹腔热灌注化疗治疗胃癌腹膜转移的病例筛选策略[J]. 中国肿瘤临床, 2020, 47(3):128-134. |
| [31] | Brenkman HJF, Päeva M, van Hillegersberg R, et al. Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer-a systematic review[J]. J Clin Med, 2019, 8(10):1658. |
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