| Research background and objectiveChina is a country with a high incidence and mortality rate of gastric cancer.Understanding the factors associated with the prognosis of gastric cancer is crucial for the postoperative treatment options and prognosis of patients.Tumor deposit is a classic pathological phenomenon,have been used as an independent risk factor for the prognosis of gastric cancer.In the 5th edition of the AJCC/UICC guidelines for colorectal cancer,tumor deposits were officially included in the TNM staging as an important prognostic factor.The 8th edition of the AJCC/UICC gastric cancer staging guidelines recommend the tumor deposit as metastatic lymph nodes to evaluate prognosis.The morphology,contour,and size do not affect their prognostic value.Currently,there are few international studies on gastric tumor deposit,the recommendation may be just a summary of experience for lock of higher level of medical evidence support.Patients with tumor deposit have a poor prognosis,although D2 radical surgery and adjuvant chemotherapy are performed,the overall prognosis of the positive group is still worse than that of the negative group.Therefore,more targeted treatment is urgently needed in clinical work.In recent years,the emerging hyperthermic intraperitoneal chemotherapy(HIPEC)has unique therapeutic value for gastric cancer patients,and it is still unclear whether it can improve the prognosis of gastric cancer patients with tumor deposit.Therefore,this study aims to investigate the safety of HIPEC and the therapeutic value of gastric cancer patients with tumor deposit.MethodsA total of 1244 patients with gastric cancer who underwent D2 radical surgery in our hospital from May 2011 to January 2014 were enrolled in the study.The propensity score matching(PSM)was used to match the age,gender,BMI,T stage,N stage,surgical resection range,tumor location,and tumor size,8 factors associated with surgical complications.The postoperative exhaust defecation time,abdominal bleeding,anastomotic leakage,chylous leakage,abdominal infection,surgical incision split,incidence of hypoproteinemia was compared between the two groups to evaluation of the safety of HIPEC.According to the postoperative pathology whether the tumor deposit were positive or not,the number of tumor deposit were included into N stage,the PSM was used to balanced the age,gender,T stage,N stage,tumor differentiation,tumor size,tumor location,surgical resection range,perineural invasion,vascular invasion,whether or not underwent HIPEC between two groups.The prognosis of the two groups and the therapeutic value of HIPEC for tumor deposit positive patients were compared.Survival analysis was performed by Kaplan-Meier method.The survival rate between the two groups was compared by log-rank test.The COX proportional hazard model was used for univariate and multivariate analysis.ResultsAmong 1244 patients with gastric cancer,188 patients underwent HIPEC and1056 patients who did not underwent HIPEC.After matching,184 patients in the HIPEC group,an identical number of patients who did not receive HIPEC were included as a reference group for prognostic comparison,the baseline data of the two groups were matched well(P>0.05).The postoperative exhaust defecation time of the patients in the HIPEC group was 3.201±1.121 days,and 3.234±1.149 days in non-HIPEC group.The difference was not statistically(P=0.783)in abdominal bleeding(χ~2=0.114),anastomotic leakage(χ~2=0.262),chylous leakage(χ~2=0.094),abdominal infection(χ~2=0.212),and surgical incision split(χ~2=0.094)(P>0.05).The rate of hypoproteinemia was 9.68%in HIPEC group,and the rate of hypoproteinemia in the non-HIPEC group was 4.3%.The difference was statistically significant(P=0.039).Among the enrolled patients,there were 152 tumor deposit positive patients and1092 patients without tumor deposit.After matching,134 patients with tumor deposit and 134 patients without tumor deposit.The baseline data of the two groups were balanced(P>0.05).The five-year survival rate of patients with tumor deposit was18.7%,and that of the negative group was 28.4%,the difference was statistically significant(HR:1.691,95%CI:1.018~1.764,P=0.037).The five-year survival rate of patients in the HIPEC group was 28.0%.The five-year survival rate of patients did not undergo HIPEC was 21.1%,and the difference was not statistically significant(HR:0.766,95%CI:0.572~1.026,P=0.074).Subgroup analysis showed that the prognosis of patients with tumor deposit underwent HIPEC was better than that did not underwent HIPEC,the difference was statistically significant(P<0.05),however,the comparison of survival rate between patients without tumor deposit if underwent HIPEC was not statistically significant(P>0.05).Univariate analysis indicated:T stage(HR:1.758,95%CI:1.426~2.168,P<0.001),N stage(HR:1.750,95%CI:1.451~2.111,P<0.001),perineural invasion(HR:2.214,95%CI:1.542~3.217,P<0.001),vascular invasion(HR:1.962,95%CI:1.307~2.945,P=0.001),tumor deposit(HR:1.691,95%CI:1.018~1.764,P=0.037),degree of differentiation(HR:0.642,95%CI:0.419~0.983,P=0.041)was associated with the prognosis of patients with gastric cancer.Although HIPEC and tumor differentiation were not significant in univariate analysis(both P>0.05),considering their significant impact on the prognosis of gastric cancer,COX multivariate analysis was included.Multivariate analysis suggested that tumor deposit positive was an independent risk factor for the prognosis of gastric cancer(HR:1.541,95%CI:1.165~2.039,P=0.002),in addition to late T stage(HR:1.589,95%CI:1.266~1.994,P<0.001),late N stage(HR:1.622,95%CI:1.335~1.970,P<0.001)and perineural invasion(HR:1.604,95%CI:1.008~2.552,P=0.046).ConclusionsHIPEC may result in hypoproteinemia,but overall it is relatively safe.Tumor deposit is one of the independent risk factors for the prognosis of gastriccancer,concluded tumor deposits into lymph nodes may not appropriatly reflect patients’prognosis,for tumor deposit positive patients,HIPEC may improve the overall prognosis compared with no-HIPEC. |
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