Efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy for locally advanced gastric cancer

doi:10.16139/j.1007-9610.2023.04.013

Abstract

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

CLC Number:

R735.2

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.

Figures/Tables 4

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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