改良HIPEC对预防局部进展期胃癌复发的作用及安全性评价  

Efficacy and safety of optimized hyperthermic intraperitoneal chemotherapy in preventing localized advanced gastric cancer recurrence

作　　者：钱可扬 茆勇[1] 陆庭勋[1] 孙俊杰 高翔[1] 蔡东焱[1] Keyang Qian;Yong Mao;Tingxun Lu;Junjie Sun;Xiang Gao;Dongyan Cai(Department of Oncology,Affiliated Hospital of Jiangnan University,Wuxi 214122,China)

机构地区：[1]江南大学附属医院肿瘤内科,江苏省无锡市214122

出　　处：《中国肿瘤临床》2022年第16期834-839,共6页Chinese Journal of Clinical Oncology

基　　金：无锡市卫生和计划生育委员会科研适宜技术推广项目(编号:ZM004)资助。

摘　　要：目的:分析真实世界中改良腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)在预防进展期胃癌复发中的作用并评价其安全性。方法:选取2017年8月至2020年11月就诊于江南大学附属医院并行根治术后HIPEC的48例ⅡB~ⅢC期胃癌患者作为HIPEC组;将同期80例根治术后仅接受静脉化疗的ⅡB~ⅢC期胃癌患者作为对照组,比较两组患者肿瘤无病生存期及不良反应的差异。结果:HIPEC组3年复发率显著优于对照组(37.5%vs.72.5%,P<0.05);对照组中位无病生存期(disease-free survival,DFS)显著低于HIPEC组(17.2 vs.25.4,P<0.05)。多因素Cox回归分析结果显示:HIPEC是预防进展期胃癌复发的独立保护因素(HR=0.465,95%CI:0.269~0.803;P<0.01);在热灌注治疗中选择白蛋白紫杉醇可显著减少肿瘤复发率(HR=0.385,95%CI:0.178~0.831;P=0.015),HIPEC组骨髓抑制发生率更低(HR=0.305,95%CI:0.136~0.682;P<0.05)。HIPEC主要的急性期不良反应为无菌性腹膜炎,部分患者远期出现肝功能异常,但两组间差异无统计学意义(P>0.05)。结论:根治术后行改良HIPEC可以改善中晚期胃癌患者的预后,其骨髓抑制的发生率更低,且该置管方法不良事件的发生可控,能满足治疗需要。而使用白蛋白紫杉醇作为HIPEC的药物似乎更能改善患者的预后。Objective:To analyze the effect of optimized hyperthermic intraperitoneal chemotherapy(HIPEC)on the prevention of advanced gastric cancer recurrence and evaluate its safety.Methods:From August 2017 to November 2020,48 patients with stageⅡB toⅢC advanced gastric cancer who received HIPEC after radical operation at Affiliated Hospital of Jiangnan University were included in the HIPEC group.Simultaneously,80 patients with stageⅡB toⅢC gastric cancer who only received intravenous chemotherapy after radical resection were included in the control group.We compared differences in disease-free survival(DFS)and side effects between the two groups.Results:The 3-year recurrence rate was significantly lower in the HIPEC group than in the control group(37.5%vs.72.5%,P<0.05).The median DFS was significantly lower in the control group than in the HIPEC group(17.167 vs.25.400,P<0.05).Multivariate Cox regression analysis showed that HIPEC was an independent protective factor against advanced gastric cancer recurrence(HR=0.465,95%CI:0.269-0.803,P<0.01).Furthermore,the selection of albumin paclitaxel in thermal perfusion therapy significantly reduced tumor recurrence rates(HR=0.385,95%CI:0.178-0.831,P=0.015).Moreover,the incidence of bone marrow suppression was lower in the HIPEC group than in the control group(HR=0.305,95%CI:0.136-0.682,P<0.05).However,the main acute HIPEC adverse reaction was aseptic peritonitis.Although some patients had long-term liver dysfunction,there was no statistical difference between the two groups(P>0.05).Conclusions:After radical operation,optimized HIPEC can improve the prognosis of patients with advanced gastric cancer.Consequently,the occurrence of adverse events owing to the catheterization method is controllable,which may comply with treatment needs.Moreover,using albumin paclitaxel in HIPEC appears to improve the prognosis of patients.

关 键 词：胃癌 浆膜浸润 腹腔热灌注化疗 无病生存期 

分 类 号：R735.2[医药卫生—肿瘤]