李雁, 周云峰, 谢丛华, 彭春伟, 黄超群, 杨肖军, 程伏林, 熊斌, 杨国樑. 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[J]. 中国肿瘤临床, 2012, 39(22): 1734-1740. DOI: 10.3969/j.issn.1000-8179.2012.22.012
引用本文: 李雁, 周云峰, 谢丛华, 彭春伟, 黄超群, 杨肖军, 程伏林, 熊斌, 杨国樑. 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[J]. 中国肿瘤临床, 2012, 39(22): 1734-1740. DOI: 10.3969/j.issn.1000-8179.2012.22.012
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Yan LI, Yunfeng ZHOU, Conghua XIE, Chunwei PENG, Chaoqun HUANG, Xiaojun YANG, Fulin CHENG, Bin XIONG, Guoliang YANG. Cytoreductive Surgery plus Hyperthermic Intra-peritoneal Chemotherapy for Peritoneal Carcinomatosis from Gastric Cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2012, 39(22): 1734-1740. DOI: 10.3969/j.issn.1000-8179.2012.22.012
Citation: Yan LI, Yunfeng ZHOU, Conghua XIE, Chunwei PENG, Chaoqun HUANG, Xiaojun YANG, Fulin CHENG, Bin XIONG, Guoliang YANG. Cytoreductive Surgery plus Hyperthermic Intra-peritoneal Chemotherapy for Peritoneal Carcinomatosis from Gastric Cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2012, 39(22): 1734-1740. DOI: 10.3969/j.issn.1000-8179.2012.22.012
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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

Cytoreductive Surgery plus Hyperthermic Intra-peritoneal Chemotherapy for Peritoneal Carcinomatosis from Gastric Cancer

    摘要
  • 摘要:
      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120 mg加顺铂120 mg，溶于生理盐水12 L，温度（43±0.5）℃，时间60~90 min。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。

     

    Abstract:
      Objective   This work aimed to study the efficacy and safety of cytoreductive surgery (CRS) plus hyperthermic in tra-peritoneal chemotherapy (HIPEC) on peritoneal carcinomatosis (PC) from gastric cancer.
      Methods  A total of 106 gastric cancer patients with PC were randomized into the CRS group (n=45) and the CRS+HIPEC group (n=61). The former group received conventional radical surgery, and the latter group underwent maximal CRS and HIPEC therapy using hydroxycamptothecin 20 mg plus mitomycin 30 mg, or docetaxel 120 mg plus cisplatin 120 mg in 12, 000 mL of normal saline at 43±0.5℃ for 60 min to 90 min. The primary endpoint was overall survival (OS), and the secondary endpoint was severe adverse events (SAE).
      Results  The major clinico-pathological characteristics were well-balanced between the CRS and CRS+HIPEC groups. By the end of the follow-up (median, 30 mo), the gastric cancer PC-related death rates were 93.3% (42/45) in the CRS group and 77.0% (47/61) in CRS+HIPEC group (P < 0.05). The median OS were 7.0 mo (95%CI 5.8 mo to 8.2 mo) in the CRS group, but 11.1 mo (95% CI 8.3 mo to 13.9 mo) in the CRS+HIPEC group (P=0.003). SAE occurred in 6 patients in the CRS group and 8 in the CRS+HIPEC group (P >0.05). Multivariate analysis showed 5 independent factors for achieving survival improvement, including CRS+HIPEC, gastric cancer with synchronous PC, complete cytoreduction, no SAE and systemic chemotherapy over 6 cycles.
      Conclusion   CRS+HIPEC could improve the survival of gastric cancer patients with synchronous PC without significant increase of SAE.

     

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