Important Predictive Factors for the Prognosis of Patients With Peritoneal Metastasis of Gastric Cancer.

Autor: Torun BC; Department of General Surgery, University of Ministry of Health, Haseki Training and Research Hospital, Istanbul, Turkey., Sobutay E; Department of General Surgery, Koç Foundation American Hospital, Istanbul, Turkey., Akbulut OE; Department of Anesthesiology, Koç Foundation American Hospital, ICU, Istanbul, Turkey., Saglam S; Department of Medical Oncology, Demiroglu Bilim University, Istanbul, Turkey., Yilmaz S; Department of Pathology, Koç Foundation American Hospital, Istanbul, Turkey., Yonemura Y; Department of Regional Cancer Therapy, Peritoneal Surface Malignancy Center, Kishiwada, Tokushukai Hospital, Kishiwada-Osaka, Japan., Canbay E; NPO for Peritoneal Surface Malignancies Program of Turkey, Husrev Gerede Caddesi, Istanbul, Turkey. drecanbay@gmail.com.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Sep; Vol. 31 (9), pp. 5975-5983. Date of Electronic Publication: 2024 May 28.
DOI: 10.1245/s10434-024-15499-z
Abstrakt: Background: This study investigated predictive factors for patients with peritoneal metastases of gastric cancer (PMGC) who underwent conversion cytoreductive surgery (C-CRS) and hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) after responding to induction chemotherapy (laparoscopic HIPEC [LHIPEC]) followed by concomitant systemic and intraperitoneal chemotherapy (bidirectional intraperitoneal and systemic chemotherapy [BIC]).
Methods: Diagnostic laparoscopy was performed for 62 patients with PMGC between January 2017 and December 2022. The patients underwent LHIPEC and BIC induction chemotherapy using intraperitoneal docetaxel (30 mg/m 2 ) and cisplatin (30 mg/m 2 ), and intravenous chemotherapy for three cycles. The predictive parameters for progression-free and overall survival were analyzed using Kaplan-Meier and Cox regression analyses. The optimal cutoff values for Ki-67 parameters were assessed using receiver operating characteristic curve analysis.
Results: The study retrospectively examined 36 (58 %) of 62 patients who responded to induction therapy and underwent C-CRS or HIPEC. A Ki-67 index lower than 10 (p = 0.000), lymph node involvement (LNI) less than 2 (p = 0.039), and an omental lesion size score lower than 0.5 cm (p = 0.002) were predictive of recurrence-free and overall survival in addition to completeness of cytoreduction and the peritoneal cancer index. Cox regression analysis showed that the independent factors associated with recurrence-free survival were decreased Ki-67 expression (≥10 % vs <10 %) (hazard ratio [HR] 4.7; 95 % confidence interval [CI] 1.6-5.210; p = 0.020) and LNI higher than 2 (HR 1.92; 95% CIS 0.923-4.0; p = 0.023).
Conclusions: Lymph node involvement and decreased Ki-67 expression are independent predictive factors of recurrence-free survival for patients with PMGC after induction chemotherapy.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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