Efficacy Analysis Of Postoperative Intraperitoneal Chemotherapy With Paclitaxel For T3-4 Advanced Gastric Cancer

Objective : To evaluate the efficacy and safety of postoperative adjuvant chemotherapy combined with intraperitoneal paclitaxel in patients for T3-4advanced gastric cancer.Methods:Retrospective cohort study was used to study 240 postoperative stage T3-4 gastric cancer patients from March 2014 to March 2018.Eighty of them were in the experimental group(IVIP group),who received postoperative adjuvant chemotherapy with FOLFOX regimen combined with intraperitoneal chemotherapy with paclitaxel.A total of 160 patients in the control group(IV group)were collected by 1:2 matching,and were treated with FOLFOX regimen only.Both groups completed at least 8 cycles of intravenous chemotherapy,while the experimental group completed at least 4 cycles of intraperitoneal chemotherapy.The disease-free survival(DFS)and Overall survival(OS)of the two groups were compared by Log-rank test,and multivariate regression analysis was performed to explore the prognostic factors affecting DFS to further confirm the effect of intraperitoneal chemotherapy.Stratified analysis was used to further identify patients suitable for such a novel strategy.Results:There was a statistical difference in DFS between the two groups,P=0.018;The 3-year DFS and 5-year DFS of the IVIP group were 64.6% and47.5%,respectively,and the median DFS was 51.4 months(95%CI: 39.9-62.8months).The 3-year DFS and 5-year DFS of group IV were 50.0% and 21.0%,respectively,and the median DFS was 37.0 months(95%CI: 30.5 to 43.5 months).There was no statistically significant difference in OS,P=0.167;The 3-year OS and5-year OS of the i VIP group were 81.3% and 67.7%,respectively,and the mean OS was 56.2 months(95%CI: 52.0 ～ 60.4 months).The 3-year OS and 5-year OS of group IV were 74.1% and 56.0%,respectively,and the mean OS was 51.6 months(95%CI: 48.1-55.2 months).Median OS was not reached in both groups.The peritoneal metastasis rate was 16.3% in IVIP group and 31.3% in IV group,P=0.013.Multivariate Cox regression analysis showed that T staging(P=0.010),N staging(P=0.001),Lauren classification(P=0.025),intraperitoneal chemotherapy or not(P=0.006)were independent prognostic factors for DFS in advanced gastric cancer.Stratified analysis showed that postoperative adjuvant systemic and intraperitoneal chemotherapy could significantly improve DFS in patients with T4,N1-3,and Lauren diffuse/mixed type.In terms of safety,grade 3-4 adverse events in the two groups were mainly leucopenia,nausea and vomiting,and peripheral neurotoxicity.The incidence of abdominal pain in the IVIP group was higher than that in the IV group,but there was no statistical significance.In addition,there were no treatment-related abdominal infections or ileus.Conclusion:Compared with intravenous chemotherapy alone,postoperative intraperitoneal(IP)paclitaxel combined with intravenous chemotherapy can significantly improve DFS and reduce the rate of peritoneal metastasis for T3-4advanced gastric cancer.And it is worthy of further study because of good safety and convenient operation.