Abstract
The present study demonstrated prognostic factors for long-term survival in patients after a comprehensive treatment (CHT) for peritoneal metastasis (PM) from gastric cancer (GC). Materials and Methods: Among 419 patients treated with neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), 266 (63.5%) patients received complete resection (CC-0) of the macroscopic tumors. In total, 184 (43.9%) patients were treated with postoperative systemic chemotherapy. Results: All patients treated who received incomplete cytoreduction (CC-1) died of GC within 6 years. In contrast, 10- year survival rates (-YSR) of CC-0 resection were 8.3% with median survival time (MST) of 20.5 months. Post-NIPS peritoneal cancer index (PCI) ≤11, and pre-NIPS PCI ≤13 were the significant favorable prognostic factors. Patients with numbers of involved peritoneal sectors ≤5 survived significant longer than those with ≥6. Both negative pre- and post-NIPS cytology was associated with significant favorable prognosis. Multivariate analyses identified pre-PCI (≤13 vs. ≥14), and cytology after NIPS (negative cytology vs. positive cytology) as independent prognostic factors. Ten year-survivors were found in patients with involvement of the greater omentum (9%), pelvic peritoneum (3%), para-colic gutter (13.9%), upper jejunum (5.6%), lower jejunum (5.5%), spermatic cord (21.9%), rectum (9.5%), ureter (6.3%), ovary (6.7%), and diaphragm (7.0%) at the time of cytoreduction. Twenty-one patients survived longer than 5 years, and 17 patients are still alive without recurrence. Conclusions: GC-PM should be removed aggressively, in patients with PCI after NIPS ≤11, PCI before NIPS ≤13, mall bowel PCI ≤2, and complete cytoreduction should be performed for metastasis in ≤5 peritoneal sectors.
Highlights
Despite the recent development of new chemotherapeutic drugs and molecular targeted drugs, the results of systemic chemotherapy for peritoneal metastasis (PM) from gastric cancer (GC) patients remain very poor [1,2,3]
It can be concluded that complete macroscopic cytoreduction is essential, but that patients with residual microscopic burden higher than the level that cannot be completely eradicated by intraoperative hyperthermic intraperitoneal chemoperfusion (HIPEC) and postoperative chemotherapy does not significantly lead to an improved overall survival even after CC-0 cytoreduction
Regarding the prognostic factors except CCR score, the present study demonstrated that prePCI ≥14, post-peritoneal cancer index (PCI) ≥12, post-Small bowel PCI (SB-PCI) ≥3, histologic non-responder status, lymph node involvement of pN2/pN3, positive cytology before and after neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), macroscopic PM, and number of involved peritoneal sectors ≥5 were significant factors indicating poor prognosis even after complete cytoreduction
Summary
Despite the recent development of new chemotherapeutic drugs and molecular targeted drugs, the results of systemic chemotherapy for peritoneal metastasis (PM) from gastric cancer (GC) patients remain very poor [1,2,3]. Hong et al reported that median overall survival of GC patients with PM treated with systemic chemotherapy alone was 12.5 months (95% CI; 9.4–15.5 months) and all patients died within 5 years [4]. In 1999, the Peritoneal Surface Oncology Group International (PSOGI) proposed a novel therapeutic approach, combining cytoreductive surgery and perioperative chemotherapy (POC) for patients with. Yonemura and Glehen reported that the overall median survival time (MST) after the treatment ranged from 9.5 to 20.5 months, and 5-year survival rates were 18% and 13% [6,7]. Long term survival was significantly better after the treatment than after systemic chemotherapy alone [4,6,7]
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