Study On The Efficacy And Safety Of Intraperitoneal Hyperthermic Chemotherapy In The Treatment Of Advanced Gastric Cancer

Objective:to investigate the efficacy and safety of intraperitoneal hyperthermic chemotherapy(HIPEC)in the treatment of advanced gastric cancer.Methods: One hundred and twenty-five patients with advanced gastric cancer who received intraperitoneal hyperthermic chemotherapy in Xiangya Hospital of Central South University from October 2017 to December 2020 were divided into prevention group,treatment group and conversion treatment group according to different treatment methods.At the same time,121 patients with advanced gastric cancer who did not receive intraperitoneal hyperthermic chemotherapy were collected as controls.Each group was divided into HIPEC group and control group according to whether they were treated with HIPEC or not.The survival and safety of each HIPEC group and control group were compared among the three groups.In addition,gastric cancer patients with tumor invasion depth of T3 in the prevention group were selected to compare the survival and peritoneal recurrence rate between the HIPEC group and the control group.Results: The main clinicopathological features of patients in each group were basically the same.In the prevention group,the 1-,2-and 3-year survival rates of patients in the HIPEC group and the control group were(100% vs.85.9%,P=0.002),(78.6% vs.53.0%,P=0.003)and(48.6% vs.41.8% P=0.306),respectively.The median survival time of the two groups was 34.0 months,95%CI(22.4-45.5 months)and 29.0 months,95%CI(17.6-40.3 months).The total survival time and disease-free survival time were tested by Log-rank,P values were 0.043 and 0.054,respectively.The difference of total survival time was statistically significant.The 1-,2-and 3-year disease-free survival rates of the two groups were(92.6% vs.79.7%,P=0.038),(64.1% vs.43.8%,P=0.026)and(45.9% vs.39.1%,P=0.303),respectively,and the median disease-free survival time was 31.0 months,95% CI(15.4-46.5 months)and 20.0 months,95 CI(14.1-25.8 months),respectively.The peritoneal metastasis rates of the two groups were 17.6% and 31.3% respectively,P=0.026.Multivariate Cox regression analysis showed that the N stage of lymph node in AJCC eighth edition was an independent risk factor affecting the survival time of patients in prevention group(HR=1.477,95%CI:1.172-1.860).For the patients with gastric cancer in stage T3 in the prevention group,the 1-,2-and 3-year survival rates of the HIPEC group and the control group were(100% vs.90.7%,P=0.042)and(82.9% vs.55.6%,P=007)and(49.2% vs.38.4%,P=0.258)respectively.The 2-year and 3-year disease-free survival rates were(100% vs.83.7%,P=0.006),(66.9% vs.44.2%,P= 0.040)and(47.2% vs.37.2%,P=0.263),respectively.The 1-and 2-year disease-free survival rates were statistically significant.The median disease-free survival time of the two groups was 31.0 months,95%CI(11.8-50.1 months)and 21.0 months,respectively.95%CI(15.6-26.3 months).In terms of peritoneal metastasis,the postoperative peritoneal recurrence rates of the two groups were 10.6% and 32.6% respectively,P=0.0046,and the difference was statistically significant.In the treatment group,the 3-year survival rate in the HIPEC group was 14.0%,while no patients in the control group survived for more than 3 years.The median survival time of HIPEC group and control group was 18.0months,95%CI(16.2-19.7months)and 11.0months,95%CI(9.812.1 months),respectively.The total survival time was tested by Log-rank,P values were 0.016,and the difference was statistically significant.Multivariate Cox regression analysis showed that tumor size(HR=2.286,95%CI:1.046-4.492)and intraperitoneal hyperthermic perfusion chemotherapy(HR=20.339,95%CI:0.172-0.668)were independent risk factors for survival in the treatment group.In the conversion treatment group,the 3-year survival rate in the HIPEC group was 15.8%,while there were no patients in the control group who survived more than 3 years.The median survival time of HIPEC group and control group was 10.0 months,95%CI(7.2-12.7 months)and 10.0 months,95%CI(9.1-10.8 months),respectively.The total survival time was tested by Log-rank,P values were 0.049,The difference was statistically significant.The R0 resection rates of HIPEC group and control group were 19.4% and 5.7% respectively,P=0.188,and the difference was not statistically significant.Multivariate Cox regression analysis showed that R0 resection was an independent prognostic factor affecting the survival time of the treatment group(HR=0.106,95%CI:0.025-0.447).In terms of safety,the incidence of postoperative adverse events in the prevention group,the HIPEC group and the control group was 5.9% and 9.4% respectively,P=0.688.In the treatment group,the incidence of postoperative adverse events in the two groups was 8.0% and 13.6% respectively,P=0.963.There was no statistical difference between the prevention group and the treatment group.HIPEC-related III/IV myelosuppression and severe hepatorenal insufficiency were not found in the prevention group and the treatment group.Conclusion: HIPEC can prolong the survival time and improve the prognosis of patients with advanced gastric cancer,and it is safe and controllable.For patients with radical gastric cancer whose depth of tumor invasion is in stage T3,HIPEC therapy tends to prolong the survival time of patients and can effectively reduce postoperative peritoneal recurrence and metastasis.