{"title":"腹腔灌洗细胞学阳性且无其他不可治愈因素的胃癌腹腔镜胃切除术后热腹腔化疗对预后的影响。","authors":"Chenbin Lv, Linyan Tong, Yuqin Sun, Qiuxian Chen, Yonghe Wu, Yongbin Zhang, Lisheng Cai","doi":"10.1245/s10434-025-18592-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study was designed to evaluate the prognostic impact of laparoscopic gastrectomy combined with postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients exhibiting positive peritoneal lavage cytology (CY1) without visible metastases.</p><p><strong>Methods: </strong>Data from 263 patients undergoing peritoneal lavage cytology and laparoscopic gastrectomy between December 2017 and December 2022 were retrospectively analyzed. Patients were stratified into CY1 (positive cytology) or CY0 (negative cytology) groups, with CY1 cases further subdivided into HIPEC and non-HIPEC cohorts based on postoperative HIPEC administration. Postoperative recurrence and survival outcomes were compared across cohorts.</p><p><strong>Results: </strong>Among 263 patients, 214 were CY0 and 49 CY1 with 27 CY1 patients receiving HIPEC and 22 non-HIPEC. HIPEC-treated CY1 patients demonstrated lower postoperative recurrence (66.7% vs. 90.9%) and visible peritoneal metastasis rates (29.6% vs. 59.1%) than non-HIPEC counterparts (P < 0.05). CY0 patients exhibited higher 3-year overall survival (OS) and progression-free survival (PFS) rates compared with both non-HIPEC CY1 and HIPEC-treated CY1 subgroups. HIPEC-treated CY1 patients showed superior 3-year OS (51.8% vs. 18.2%, P = 0.005) and PFS (35% vs. 13.6%, P = 0.037) than non-HIPEC CY1. Notably, stage III CY0 cohort demonstrated comparable survival outcomes to HIPEC-treated CY1 cohort (overall survival 56.4% vs. 51.8%, P = 0.39; progression-free survival 51% vs. 35%, P = 0.14). Cox analysis identified non-HIPEC and pN2-3 stage as independent risk factors for OS, while non-HIPEC, pT4, and pN2-3 stages predicted poorer PFS in CY1 patients.</p><p><strong>Conclusions: </strong>Hyperthermic intraperitoneal chemotherapy following laparoscopic gastrectomy demonstrated efficacy in reducing postoperative peritoneal metastasis rates while enhancing prognosis of CY1 patients, achieving oncologic outcomes comparable to stage III CY0 counterparts, although additional investigation remains imperative.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic Impact of Hyperthermic Intraperitoneal Chemotherapy After Laparoscopic Gastrectomy in Gastric Cancer with Positive Peritoneal Lavage Cytology and no Other Noncurative Factors.\",\"authors\":\"Chenbin Lv, Linyan Tong, Yuqin Sun, Qiuxian Chen, Yonghe Wu, Yongbin Zhang, Lisheng Cai\",\"doi\":\"10.1245/s10434-025-18592-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study was designed to evaluate the prognostic impact of laparoscopic gastrectomy combined with postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients exhibiting positive peritoneal lavage cytology (CY1) without visible metastases.</p><p><strong>Methods: </strong>Data from 263 patients undergoing peritoneal lavage cytology and laparoscopic gastrectomy between December 2017 and December 2022 were retrospectively analyzed. Patients were stratified into CY1 (positive cytology) or CY0 (negative cytology) groups, with CY1 cases further subdivided into HIPEC and non-HIPEC cohorts based on postoperative HIPEC administration. Postoperative recurrence and survival outcomes were compared across cohorts.</p><p><strong>Results: </strong>Among 263 patients, 214 were CY0 and 49 CY1 with 27 CY1 patients receiving HIPEC and 22 non-HIPEC. HIPEC-treated CY1 patients demonstrated lower postoperative recurrence (66.7% vs. 90.9%) and visible peritoneal metastasis rates (29.6% vs. 59.1%) than non-HIPEC counterparts (P < 0.05). CY0 patients exhibited higher 3-year overall survival (OS) and progression-free survival (PFS) rates compared with both non-HIPEC CY1 and HIPEC-treated CY1 subgroups. HIPEC-treated CY1 patients showed superior 3-year OS (51.8% vs. 18.2%, P = 0.005) and PFS (35% vs. 13.6%, P = 0.037) than non-HIPEC CY1. Notably, stage III CY0 cohort demonstrated comparable survival outcomes to HIPEC-treated CY1 cohort (overall survival 56.4% vs. 51.8%, P = 0.39; progression-free survival 51% vs. 35%, P = 0.14). Cox analysis identified non-HIPEC and pN2-3 stage as independent risk factors for OS, while non-HIPEC, pT4, and pN2-3 stages predicted poorer PFS in CY1 patients.</p><p><strong>Conclusions: </strong>Hyperthermic intraperitoneal chemotherapy following laparoscopic gastrectomy demonstrated efficacy in reducing postoperative peritoneal metastasis rates while enhancing prognosis of CY1 patients, achieving oncologic outcomes comparable to stage III CY0 counterparts, although additional investigation remains imperative.</p>\",\"PeriodicalId\":8229,\"journal\":{\"name\":\"Annals of Surgical Oncology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-10-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Surgical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1245/s10434-025-18592-z\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1245/s10434-025-18592-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：本研究旨在评估腹腔镜胃切除术联合术后腹腔热化疗（HIPEC）对腹膜灌洗细胞学（CY1）阳性且无明显转移的胃癌患者预后的影响。方法：回顾性分析2017年12月至2022年12月263例行腹腔灌洗细胞学检查和腹腔镜胃切除术患者的资料。将患者分为CY1（细胞学阳性）组或CY0（细胞学阴性）组，并根据术后给药情况将CY1病例进一步细分为HIPEC和非HIPEC组。比较各组患者的术后复发率和生存率。结果：263例患者中，CY0型214例，CY1型49例，其中CY1型27例接受HIPEC，非HIPEC 22例。hipec治疗的CY1患者术后复发率（66.7% vs. 90.9%）和可见腹膜转移率（29.6% vs. 59.1%）均低于非hipec患者（P < 0.05）。与非hipec CY1和hipec治疗的CY1亚组相比，CY0患者表现出更高的3年总生存率（OS）和无进展生存率（PFS）。hipec治疗的CY1患者的3年OS （51.8% vs. 18.2%, P = 0.005）和PFS （35% vs. 13.6%, P = 0.037）优于非hipec治疗的CY1患者。值得注意的是，III期CY0队列显示出与hipec治疗的CY1队列相当的生存结果（总生存率56.4%对51.8%,P = 0.39；无进展生存率51%对35%，P = 0.14）。Cox分析发现非hipec和pN2-3分期是OS的独立危险因素，而非hipec、pT4和pN2-3分期预测CY1患者较差的PFS。结论：腹腔镜胃切除术后腹腔热化疗可降低CY1期患者术后腹膜转移率，同时改善预后，达到与CY0期患者相当的肿瘤预后，尽管还需要进一步的研究。
Prognostic Impact of Hyperthermic Intraperitoneal Chemotherapy After Laparoscopic Gastrectomy in Gastric Cancer with Positive Peritoneal Lavage Cytology and no Other Noncurative Factors.
Background: This study was designed to evaluate the prognostic impact of laparoscopic gastrectomy combined with postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients exhibiting positive peritoneal lavage cytology (CY1) without visible metastases.
Methods: Data from 263 patients undergoing peritoneal lavage cytology and laparoscopic gastrectomy between December 2017 and December 2022 were retrospectively analyzed. Patients were stratified into CY1 (positive cytology) or CY0 (negative cytology) groups, with CY1 cases further subdivided into HIPEC and non-HIPEC cohorts based on postoperative HIPEC administration. Postoperative recurrence and survival outcomes were compared across cohorts.
Results: Among 263 patients, 214 were CY0 and 49 CY1 with 27 CY1 patients receiving HIPEC and 22 non-HIPEC. HIPEC-treated CY1 patients demonstrated lower postoperative recurrence (66.7% vs. 90.9%) and visible peritoneal metastasis rates (29.6% vs. 59.1%) than non-HIPEC counterparts (P < 0.05). CY0 patients exhibited higher 3-year overall survival (OS) and progression-free survival (PFS) rates compared with both non-HIPEC CY1 and HIPEC-treated CY1 subgroups. HIPEC-treated CY1 patients showed superior 3-year OS (51.8% vs. 18.2%, P = 0.005) and PFS (35% vs. 13.6%, P = 0.037) than non-HIPEC CY1. Notably, stage III CY0 cohort demonstrated comparable survival outcomes to HIPEC-treated CY1 cohort (overall survival 56.4% vs. 51.8%, P = 0.39; progression-free survival 51% vs. 35%, P = 0.14). Cox analysis identified non-HIPEC and pN2-3 stage as independent risk factors for OS, while non-HIPEC, pT4, and pN2-3 stages predicted poorer PFS in CY1 patients.
Conclusions: Hyperthermic intraperitoneal chemotherapy following laparoscopic gastrectomy demonstrated efficacy in reducing postoperative peritoneal metastasis rates while enhancing prognosis of CY1 patients, achieving oncologic outcomes comparable to stage III CY0 counterparts, although additional investigation remains imperative.
期刊介绍：
The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
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