腹腔热灌注化疗对不同病理类型和Borrmann分型进展期胃癌患者的预后分析

目的:回顾性分析行手术联合术后腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)与同期单纯手术胃癌患者的临床病理资料,以期了解HIPEC对局部进展期胃癌患者预后的影响。方法:回顾性分析2009年1月~2014年1月在天津医科大学肿瘤医院行HIPEC的80例Ⅲb期胃癌患者与同期单纯手术90例Ⅲb期胃癌患者。根据术后是否使用腹腔热灌注化疗分为HIPEC组(研究组)和单纯手术组(对照组)。研究组:印戒细胞癌24例,非印戒细胞癌56例;BorrmannⅠ型12例,BorrmannⅡ型28例,BorrmannⅢ型23例,BorrmannⅣ型17例。对照组:印戒细胞癌26例,非印戒细胞癌64例;BorrmannⅠ型15例,BorrmannⅡ型30例,BorrmannⅢ型26例子,BorrmannⅣ型19例。两组患者术后4周均予以SOX方案化疗8个疗程。分析比较不同病理类型及Borrmann分型的胃癌患者术后生存情况,并对两组患者手术相关并发症进行对比。结果:研究组和对照组患者5年生存率分别为36.25%和28.89%(P<0.05);印戒细胞癌患者中,研究组和对照组患者5年生存率分别为25.00%和15.38%(P<0.05);非印戒细胞癌患者中,研究组和对照组患者5年生存率分别为41.07%和34.38%(P>0.05);BorrmannⅠ型胃癌患者中,研究组和对照组患者5年生存率分别为41.67%和40.00%(P>0.05);BorrmannⅡ型胃癌患者中,研究组和对照组患者5年生存率分别为35.71%和33.33%(P>0.05);BorrmannⅢ型胃癌患者中,研究组和对照组患者5年生存率分别为39.13%和26.92%(P<0.05);BorrmannⅣ型胃癌患者中,研究组和对照组患者5年生存率分别为29.41%和15.79%(P<0.05)。两组患者手术相关并发症的差异无统计学意义(P>0.05)。结论:手术联合HIPEC安全可行,有利于提高患有印戒细胞癌、BorrmannⅢ型及BorrmannⅣ型进展期胃癌患者术后的5年生存率,延长生存期。

Prognostic analysis of intraoperative chemohyperthermic peritoneal perfusion in patients with advanced gastric cancer of different pathological types and Borrmann's classifications

  Objective  To understand the effect of hyperthermic intraperitoneal chemotherapy (HIPEC) on prognosis of patients with locally advanced gastric cancer, this study retrospectively analyzed the clinical and pathological data of patients undergoing surgery combined with HIPEC and those undergoing surgery alone.  Methods  We retrospectively analyzed 80 stage Ⅲb gastric cancer patients who underwent HIPEC and 90 stage Ⅲb gastric cancer patients who underwent surgery alone at Tianjin Medical University Cancer Institute and Hospital between January 2009 and January 2014. These patients were divided into the HIPEC group (study group) and the surgery group (control group). The study and control groups included 24 and 26 signet ring cell carcinoma patients and 56 and 64 non-signet ring cell carcinoma patients, respectively. The study and control groups included 12 and 15 Borrmann type Ⅰ cases, 28 and 30 Borrmann type Ⅱ cases, 23 and 26 Borrmann type Ⅲ cases, and 17 and 19 Borrmann type Ⅳ cases, respectively. Four weeks after surgery, the two groups were treated with chemotherapy using the S-1 and oxaliplatin (SOX) regimen for 8 courses. This study analyzed and compared the survival of patients with gastric cancer of different pathological types and Borrmann's classifications. The surgical complications of the two groups were retrospectively analyzed.  Results  The 5-year survival rates of the study group and the control group were 36.25% and 28.89%, respectively, and the difference was statistically significant (P < 0.05). Among the patients with signet ring cell carcinoma, the 5-year survival rates of the study group and the control group were statistically significant (25.00% vs. 15.38%, respectively, P < 0.05). There was no significant difference in the 5-year survival rate between the non-signet ring cell carcinoma patients in the study group and the control group (41.07% vs. 34.38%, respectively, P>0.05). The 5-year survival rates between Borrmann type Ⅰ and typeⅡ patients in the study and control groups were not significantly different (41.67% vs. 40.00%, 35.71% vs. 33.33%, respectively, P>0.05). There was a statistically significant difference in the 5-year survival rates between Borrmann type Ⅲ and type Ⅳ patients in the study and control groups (39.13% vs. 26.92%, 29.41% vs. 15.79%, respectively, P < 0.05). There was no significant difference in surgical complications between the two groups (P>0.05).  Conclusions  Surgery combined with HIPEC is safe and improves the 5-year survival rate of patients with advanced gastric cancer classified as signet ring cell carcinoma, Borrmann type Ⅲ, and Borrmann type Ⅳ.