术中腹腔内温热灌注化疗联合术后静脉化疗对存在腹膜微转移胃癌患者的临床疗效观察

目的探讨存在腹膜微转移的胃癌患者行术中腹腔内温热灌注化疗(IHIC)联合术后静脉化疗的临床疗效。方法将145例术中腹腔冲洗液流式细胞术(FCM)检测癌胚抗原(CEA)、细胞角蛋白20(CK-20)均表达阳性的胃癌患者随机分为对照组和治疗组。对照组72例,行静脉化疗6个周期;治疗组73例,术中行IHIC联合术后静脉化疗6个周期;2组静脉化疗均采用FOLFOX4方案,并均于术后4周开始进行。结果治疗前后平均Karnofsky评分对照组分别为(67.8±6.8)分、(73.9±9.3)分,治疗组分别为(67.9±7.8)分、(78.1±11.0)分,2组治疗后与治疗前评分比较差异均具有统计学意义(P<0.05),且治疗组治疗后评分高于对照组,差异有统计学意义(P<0.05)。2组治疗不良反应和并发症比较差异均无统计学意义(P>0.05)。对照组和治疗组5年总复发和转移率分别为63.9%、31.5%,差异有统计学意义(P<0.05)。对照组1、3、5年累积生存率分别为51.4%、25.0%和8.3%,治疗组分别为71.2%、47.9%和41.1%,差异均具有统计学意义(P<0.05)。治疗组中位生存期为36.0个月,明显优于对照组的18.0个月(P<0.05)。结论对存在腹膜微转移的胃癌患者行术中IHIC联合术后静脉化疗安全有效,可降低胃癌术后复发和转移率,改善患者健康状况和生活质量,提高术后5年生存率。

Intraoperative hyperthermic intraperitoneal chemotherapy combined with postoperative intravenous chemotherapy for gastric cancer patients with peritoneal micro-metastasis

Objective To investigate clinical efficacy of intraoperative hyperthermic intraperitoneal chemotherapy （IHIC） combined with postoperative intravenous chemotherapy for gastric cancer patients with peritoneal micro-metastasis. Methods A total of 145 gastric cancer patients with positive expression of careinoembryonic antigen （CEA） and cytokeratin 20 （CK-20） detected by Flow cytometry （FCM） were randomized into two groups. 72 patients in control group who received postoperative intravenous chemotherapy for six cycles and 73 patients in treatment group who received IHIC combined with postoperative intravenous chemotherapy for six cycles ; All patients in the two groups received the same chemo regimen FOL- FOX4 after 4 weeks of operation. Results The Karnofsky score in control group before treatment was 67.8 ± 6.8 versus 73.9 ±9.3 after treatment respectively （ P 〈0.05） , and in treatment group was 67.9±7.8 versus 78.1± 11.0 respectively （ P 〈 0.05 ）. There was no significant difference between the two groups of the Kamofsky score before treatment （ P 〉 0.05 ）, hut there was difference between the two groups after treatment （ P 〈 0.05 ）. There was no significant differences be- tween the two groups with respect to the side effects and complications （ P 〈 0. 05）. The total intraperitoneal recurrence and distant metastasis rate was 63.9% in control group versus 31.5% in treatment group respectively （ P 〈0.05）. The 1 year, 3 year and 5 year survival rates in control group were 51.4% , 25.0% and 8.3% , but were 71.2% , 47.9% and 41.1% in treatment group with significant difference （ P 〈 0.05 ）. The median survival of patients in treatment group was significantly longer those in the control group （36.0 vs. 18.0 months, P 〈 0.05）. Conclusion Intraoperative hyperthermic intraperito- heal chemotherapy （IHIC） combined with postoperative intravenous chemotherapy can reduce the intraperitoneal recurrence and distant metastasis rate and prolong survival which provides a safe and effective treatment for gastric cancer patients with peritoneal micro-metastasis.