Hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis: A multicenter propensity score-matched cohort study

Ziying Lei; Jiahong Wang; Zhi Li; Baozhong Li; Jiali Luo; Xuejun Wang; Jin Wang; Mingchen Ba; Hongsheng Tang; Qingjun He; Quanxing Liao; Xiansheng Yang; Tianpei Guan; Han Liang; Shuzhong Cui; On Behalf Of The Chinese Peritoneal Oncology Study Group

doi:10.21147/j.issn.1000-9604.2020.06.12

Hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis: A multicenter propensity score-matched cohort study

Chin J Cancer Res. 2020 Dec 31;32(6):794-803. doi: 10.21147/j.issn.1000-9604.2020.06.12.

Authors

Ziying Lei¹, Jiahong Wang¹, Zhi Li², Baozhong Li³, Jiali Luo⁴, Xuejun Wang⁵, Jin Wang¹, Mingchen Ba¹, Hongsheng Tang¹, Qingjun He¹, Quanxing Liao¹, Xiansheng Yang¹, Tianpei Guan¹, Han Liang⁵, Shuzhong Cui¹, On Behalf Of The Chinese Peritoneal Oncology Study Group^{1

2

3

4

5}

Affiliations

¹ Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China.
² Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Tumor Hospital of Henan Province, Zhengzhou 450008, China.
³ Department of Surgery, Anyang Tumor Hospital, Anyang 455000, China.
⁴ Department of Oncology, Guangzhou Medical University, Guangzhou 510095, China.
⁵ Department of Gastrointestinal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.

PMID: 33447001
PMCID: PMC7797229
DOI: 10.21147/j.issn.1000-9604.2020.06.12

Abstract

Objective: Systemic chemotherapy has limited efficacy in the treatment of peritoneal metastasis (PM) in gastric cancer (GC). Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with complete cytoreductive surgery (CRS) has shown promising outcomes but remains controversial. The present study aimed to evaluate the safety and efficacy of HIPEC without CRS in GC patients with PM.

Methods: This retrospective propensity score-matched multicenter cohort study included GC patients with PM treated with either chemotherapy alone (Cx group) or with HIPEC combined with chemotherapy (HIPEC-Cx group) in four Chinese high-volume gastric medical centers between 2010 and 2017. The primary outcomes were median survival time (MST) and 3-year overall survival (OS). Propensity score matching was performed to compensate for controlling potential confounding effects and selection bias.

Results: Of 663 eligible patients, 498 were matched. The MST in the Cx and HIPEC-Cx groups was 10.8 and 15.9 months, respectively [hazard ratio (HR)=0.71, 95% confidence interval (95% CI), 0.58-0.88; P=0.002]. The 3-year OS rate was 10.1% (95% CI, 5.4%-14.8%) and 18.4% (95% CI, 12.3%-24.5%) in the Cx and HIPEC-Cx groups, respectively (P=0.017). The complication rates were comparable. The time to first flatus and length of hospital stay for patients undergoing HIPEC combined with chemotherapy was longer than that of chemotherapy alone (4.6±2.4 dvs. 2.7±1.8 d, P<0.001; 14.2±5.8 dvs. 11.4±7.7 d, P<0.001), respectively. The median follow-up period was 33.2 months.

Conclusions: Compared with standard systemic chemotherapy, HIPEC combined with chemotherapy revealed a statistically significant survival benefit for GC patients with PM, without compromising patient safety.

Keywords: Gastric cancer; chemotherapy; hyperthermic intraperitoneal chemotherapy; peritoneal metastasis.