Objective: To investigate the efficacy of laparoscopic hyperthermic intraperitoneal perfusion chemotherapy combined with intraperitoneal and systemic chemotherapy (HIPEC-IP-IV) in the treatment of peritoneal metastases from gastric cancer (GCPM). Methods: This was a descriptive case series study. Indications for HIPEC-IP-IV treatment include: (1) pathologically confirmed gastric or esophagogastric junction adenocarcinoma; (2) age 20-85 years; (3) peritoneal metastases as the sole form of Stage IV disease, confirmed by computed tomography, laparoscopic exploration, ascites or peritoneal lavage fluid cytology; and (4) Eastern Cooperative Oncology Group performance status 0-1. Contraindications include: (1) routine blood tests, liver and renal function, and electrocardiogram showing no contraindications to chemotherapy; (2) no serious cardiopulmonary dysfunction; and (3) no intestinal obstruction or peritoneal adhesions. According to the above criteria, data of patients with GCPM who had undergone laparoscopic exploration and HIPEC from June 2015 to March 2021 in the Peking University Cancer Hospital Gastrointestinal Center were analyzed, after excluding those who had received antitumor medical or surgical treatment. Two weeks after laparoscopic exploration and HIPEC, the patients received intraperitoneal and systemic chemotherapy. They were evaluated every two to four cycles. Surgery was considered if the treatment was effective, as shown by achieving stable disease or a partial or complete response and negative cytology. The primary outcomes were surgical conversion rate, R0 resection rate, and overall survival. Results: Sixty-nine previously untreated patients with GCPM had undergone HIPEC-IP-IV, including 43 men and 26 women; with a median age of 59 (24-83) years. The median PCI was 10 (1-39). Thirteen patients (18.8%) underwent surgery after HIPEC-IP-IV, R0 being achieved in nine of them (13.0%). The median overall survival (OS) was 16.1 months. The median OS of patients with massive or moderate ascites and little or no ascites were 6.6 and 17.9 months, respectively (P<0.001). The median OS of patients who had undergone R0 surgery, non-R0 surgery, and no surgery were 32.8, 8.0, and 14.9 months, respectively (P=0.007). Conclusions: HIPEC-IP-IV is a feasible treatment protocol for GCPM. Patients with massive or moderate ascites have a poor prognosis. Candidates for surgery should be selected carefully from those in whom treatment has been effective and R0 should be aimed for.
目的： 探讨腹腔镜腹腔热灌注化疗（HIPEC）联合腹腔及系统化疗（HIPEC-IP-IV）模式治疗胃癌腹膜转移的疗效。 方法： 采用描述性病例系列研究方法。HIPEC-IP-IV治疗方案的适应证为：（1）术前病理活检证实为胃或食管胃结合部腺癌；（2）年龄20~85岁；（3）通过CT、腹腔镜探查、腹水或腹腔灌洗液细胞学证实为腹膜转移为单一Ⅳ期因素［仅纳入腹膜有转移（P1），若合并腹腔脱落细胞学检查阳性（CY1）或卵巢转移视为单一Ⅳ期因素］；（4）美国东部肿瘤协作组（ECOG）评分为0~1分。禁忌证为：（1）血常规、肝肾功能、心电图显示有化疗禁忌证；（2）伴有严重心肺功能障碍；（3）存在肠梗阻、腹膜粘连等情况。根据上述标准，排除既往接受抗肿瘤药物或手术治疗的患者。回顾性分析2015年6月至2021年3月期间北京大学肿瘤医院收治并接受HIPEC-IP-IV治疗的69例初治胃癌腹膜转移患者的临床资料。HIPEC-IP-IV模式治疗是在腹腔镜探查及腹腔热灌注化疗后2周行腹腔及系统化疗，每2~4周期进行疗效评估，对疗效达到完全缓解、部分缓解和疾病稳定，且腹腔游离细胞学转阴者，可考虑进行转化手术。主要观察指标为手术转化率、R0手术切除率和总体生存情况。 结果： 本组69例患者中男性43例，女性26例；中位年龄59（24~83）岁；腹膜癌指数评分中位数为10（1~39）分。经HIPEC-IP-IV模式治疗后，共有13例患者（18.8%）接受了手术治疗，其R0手术切除率为13.0%（9/69）。全组中位总体生存期为16.1个月，中、大量腹水患者的中位总体生存期低于无或仅少量腹水患者（6.6个月比17.9个月，P<0.001）。R0手术、非R0手术和未手术患者的中位总体生存期分别为32.8个月、8.0个月和14.9个月，差异有统计学意义（P=0.007）。 结论： HIPEC-IP-IV治疗模式可行，中量、大量腹水患者预后差。转化手术需在严格筛选的前提下进行，不推荐进行非R0手术。.