HIPEC for metastatic gastric cancer: Moving the needle towards 3-year survival

IF 3.5 2区 医学 Q2 ONCOLOGY
Ejso Pub Date : 2024-10-25 DOI:10.1016/j.ejso.2024.108790
Neal Bhutiani , Y. David Seo , Kristen A. Robinson , Michael G. White , Naruhiko Ikoma , Paul F. Mansfield , Jenny J. Li , Mariela Blum Murphy , Jaffer A. Ajani , Brian D. Badgwell
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引用次数: 0

Abstract

Introduction

Prior work has established hyperthermic intraperitoneal chemotherapy (HIPEC) administration as a safe treatment option for select patients with gastric adenocarcinoma and carcinomatosis. However, identifying patients who will maximally benefit from HIPEC remains unclear. This study assessed a single-institution experience with HIPEC for metastatic gastric cancer to identify variables associated with improved survival.

Methods

A database of patients treated for metastatic gastric adenocarcinoma at MD Anderson Cancer Center from 2013 to 2022 was queried for patients undergoing HIPEC as part of their treatment regimen. Patients were stratified by overall survival (OS)≥36 months or <36 months and assessed along demographic and clinicopathologic variables to identify factors associated with OS ≥ 36 months.

Results

Among 104 patients, 1,2, and 3-year OS from diagnosis was 89 %,44 %, and 18 %. Patients with OS ≥ 36 months were more likely to have moderately differentiated tumors, positive cytology only (i.e. no visible carcinomatosis), and lower peritoneal cancer index (PCI) than those with OS < 36 months (p = 0.002, p = 0.01, p = 0.001,respectively). Groups did not otherwise differ with respect to demographic parameters or treatment or pathologic details. Among patients who underwent gastrectomy, those with OS < 36 months had higher pathologic T and N category (p = 0.003 and p = 0.02, respectively). Postoperative mortality was zero in both groups among patients undergoing gastrectomy.

Conclusions

HIPEC may provide more durable survival benefit among patients with metastatic gastric cancer with moderately differentiated disease, low PCI, and positive cytology alone. Additionally, among patients who undergo gastrectomy, higher final pathologic T and N category are associated with worse survival. Trials are needed to compare 3-year OS rates in patients treated with HIPEC versus systemic therapy alone.
转移性胃癌的 HIPEC 治疗:向 3 年生存率迈进。
导言:先前的研究已经证实,对部分胃腺癌和癌肿患者来说,腹腔内热化疗(HIPEC)是一种安全的治疗方案。然而,如何确定哪些患者能从 HIPEC 中获得最大疗效仍不清楚。本研究评估了单个机构使用 HIPEC 治疗转移性胃癌的经验,以确定与提高生存率相关的变量:对2013年至2022年期间在MD安德森癌症中心接受转移性胃腺癌治疗的患者数据库进行了查询,以了解作为治疗方案一部分接受HIPEC治疗的患者情况。根据总生存期(OS)≥36 个月或结果对患者进行分层:在104名患者中,自确诊起1年、2年和3年的OS分别为89%、44%和18%。与OS≥36个月的患者相比,OS≥36个月的患者更有可能患有中度分化肿瘤、细胞学阳性(即无明显癌变)以及腹膜癌指数(PCI)较低:HIPEC可为中度分化、低PCI和仅细胞学阳性的转移性胃癌患者带来更持久的生存获益。此外,在接受胃切除术的患者中,最终病理T和N分类越高,生存率越低。需要进行试验,比较接受HIPEC治疗与单纯接受系统治疗的患者的3年生存率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Ejso
Ejso 医学-外科
CiteScore
6.40
自引率
2.60%
发文量
1148
审稿时长
41 days
期刊介绍: JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.
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