Abstract
BackgroundSelection criteria and prognostic factors for patients with advanced gastric cancer (AGC) undergoing cytoreductive surgery (CRS) plus hyperthermic intra-operative peritoneal chemotherapy (HIPEC) have not been well defined and the literature data are not homogeneous. The aim of this study was to compare prognostic factors influencing overall (OS) and disease-free survival (DFS) in a population of patients affected by AGC with surgery alone and surgery plus HIPEC, both with curative (PCI, Peritoneal Carcinomatosis Index >1) and prophylactic (PCI=0) intent.MethodsA retrospective analysis of a prospectively collected database was conducted in patients affected by AGC from January 2006 to December 2015. Uni- and multivariate analyses of prognostic factors were performed.ResultsA total of 85 patients with AGC were analyzed. Five-year OS for surgery alone, CRS plus curative HIPEC, and surgery plus prophylactic HIPEC groups was 9%, 27%, and 33%, respectively. Statistical significance was reached comparing both prophylactic HIPEC vs surgery alone group (p = 0.05), curative HIPEC vs surgery alone group (p = 0.03), and curative vs prophylactic HIPEC (p = 0.04).Five-year DFS for surgery alone, CRS + curative HIPEC, and surgery + prophylactic HIPEC groups was 9%, 20%, and 30%, respectively. Statistical significance was reached comparing both prophylactic HIPEC vs surgery alone group (p < 0.0001), curative HIPEC vs surgery alone group (p = 0.008), and curative vs prophylactic HIPEC (p = 0.05).ConclusionsPatients with AGC undergoing surgery plus HIPEC had a better OS and DFS with respect to patients treated with surgery alone.
Highlights
Gastric cancer is the sixth most prevalent malignant tumor worldwide and the third leading cause of cancer-related death
Patients with advanced gastric cancer (AGC) undergoing surgery plus hyperthermic intra-operative peritoneal chemotherapy (HIPEC) had a better OS and disease-free survival (DFS) with respect to patients treated with surgery alone
We demonstrated that tumor location, advanced T stage, PCI >6, CC score >0, N+, type of resection, and the use of HIPEC significantly affected both OS and DFS
Summary
Gastric cancer is the sixth most prevalent malignant tumor worldwide and the third leading cause of cancer-related death. Patients with AGC and peritoneal carcinomatosis (PC) have a poor prognosis, with a median survival of 3.1 months without treatment [5]. Systemic chemotherapy extended the median survival time to 11 months in patients with AGC compared with best supportive care alone [6]. Selection criteria and prognostic factors for patients with advanced gastric cancer (AGC) undergoing cytoreductive surgery (CRS) plus hyperthermic intra-operative peritoneal chemotherapy (HIPEC) have not been well defined and the literature data are not homogeneous. The aim of this study was to compare prognostic factors influencing overall (OS) and disease-free survival (DFS) in a population of patients affected by AGC with surgery alone and surgery plus HIPEC, both with curative (PCI, Peritoneal Carcinomatosis Index >1) and prophylactic (PCI=0) intent.
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