Оценка эффективности перфузионной термохимиотерапии при раке желудка по результатам проспективного рандомизированного исследования

М. Ю. Ревтович ГУО «Белорусская медицинская академия последипломного образования», г. Минск

2021 №3 | Оригинальные научные публикации

Аннотация

Список литературы

В статье проанализированы результаты проспективного рандомизированного исследования, в котором было проведено лечение 154 пациентов резектабельным раком желудка (РЖ) IIBIIIC стадий (IIIIV тип по Borrmann), у 76 из них была проведена интраоперационная перфузионная термохимиотерапия (ИПТХТ). Отмечено, что комбинация радикальной операции и ИПТХТ в прогностически неблагоприятной когорте пациентов сопровождается: снижением частоты случаев прогрессирования (р = 0,009), метахронной перитонеальной диссеминации (р < 0,001), 5летней кумулятивной инцидентности канцероматоза с 70,7 ± 6,8 % до 23,6 ± 5,2 % (р < 0,001), что создает предпосылки для увеличения 5летней выживаемости (скорректированной – с 27,0 ± 6,7 % до 45,1 ± 6,4 % (р = 0,05); свободной от прогрессирования – с 16,3 ± 5,5 % до 42,1 ± 6,3 % (р < 0,001); свободной от диссеминации –с 19,4 ± 5,9 % до 45,2 ± 6,3 % (р = 0,001).

Ключевые слова:

рак желудка, интраоперационная перфузионная термохимиотерапия, канцероматоз, кумулятивная инцидентность

Efficacy of perfusion thermochemotherapy in gastric cance management based on results of prospective randomized study

The article analyses the results of a prospective randomized study of a cohort of 154 radically operated patients with stage IIBIIIC gastric cancer (Borrmann type IIIIV). 76 patients were administered intraoperative perfusion thermochemotherapy (HIPEC). It was noted that enhancing radical surgery procedure by complementing it with HIPEC in managing this prognostically unfavorable group of patients resulted in a decrease in the frequency of progression cases (р = 0.009), metachronous peritoneal dissemination – (р < 0.001), and 5year cumulative carcinomatosis incidence – 70.7 ± 6.8 % to 23.6 ± 5.2 % (р < 0.001) thereby building a groundwork for improving 5year adjusted survival rate from 27.0 ± 6.7 % to 45.1 ± 6.4 % (р = 0.05), progressionfree survival – from 16.3 ± 5.5 % to 42.1 ± 6.3 % (р < 0.001), and disseminationfree survival – from 19.4 ± 5.9 % to 45.2 ± 6.3 % (р = 0.001).

Keywords

gastric cancer, intraoperative intraperitoneal hyperthermic chemotherapy, canceromatosis, cumulative incidence

Литература
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7. Fine, J. P., Gray R. J. A proportional hazards model for the subdistribution of a competing risk // J. Am. Stat. Assoc. – 1999. – Vol. 94. – P. 496–509.
8. Therneau, T., Grambsch, P. Modeling Survival Data: Extending the Cox Model. – Springer-Verlag, 2000. – 350 p.
9. R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, URL http://www.R-project.org/. – Date of access: 21.01.2021.
10. Gray, B. (2014). cmprsk: Subdistribution Analysis of Competing Risks. R package version 2.2-7. – Mode of access: http://CRAN. R-project.org/package=cmprsk. – Date of access: 18.08.2017.
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13. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer / T. D. Yan, D. Black, P. H. Sugarbaker [et al.] // Ann. Surg. Oncol. – 2007. – Vol. 14. – P. 2702–2713.
14. Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials / F. Coccolini, E. Cotte, O. Glehen [et al.] // Eur. J. Surg. Oncol. – 2014. – Vol. 40. – P. 12–26.
15. Kim, J.-I. A controlled clinical trial of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP) / J.-I. Kim, H.-S. Bae // Gastric Cancer. – 2001. – Vol. 4. – P. 27–33.
16. Reutovich, M. Y. Efficacy of Adjuvant Systemic Chemotherapy Combined with Radical Surgery and Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer Treatment / M. Y. Reutovich, O. V. Krasko, O. G. Sukonko // Indian J. Surg. Oncol. – 2020. – Vol. 11. – P. 337–343.
References
1. Cunliffe, W. J. Gastrointestinal malignancy: rational for adjuvant therapy using early intraoperative intraperitoneal chemotherapy (EPIC) / W. J. Cunliffe, P. H. Sugarbaker // Brit. J. Surg. – 1989. – Vol. 76. – P. 1082–1090.
2. Glehen, O. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia / O. Glehen, F. Mohamed, F. N. Gilly // Lancet Oncol. – 2004. – № 5. – Р. 219–228. –
doi: 10.1016/S1470–2045(04)01425–1
3. Continuous hyperthermic peritoneal perfusion for the prevention of peritoneal recurrence of gastric cancer: Randomized controlled study / T. Fujimura, Y. Yonemura, K. Muraoka [et al.] // World J. Surg. – 1994. – Vol. 18. – P. 150–155.
4. Intraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: Final results of a randomized controlled study / Y. Yonemura, de X. Aretxabala, T. Fujimura [et al.] // Hepatogastroenterology. – 2001. – Vol. 48. – P. 1776–1782.
5. Reutovich, M. Yu. Hyperthermic intraperitoneal chemotherapy in serosa-invasive gastric cancer patients /M. Yu. Reutovich, O. V. Krasko, O. G. Sukonko // Eur. J. Surg. Oncol. – 2019. – Vol. 45(12). – P. 2405–2411.
6. Gray, R. J. A class of k-sample tests for comparing the cumulative incidence of a competing risk // Ann. Statistics. – 1988. – Vol. 16. – P. 1141–1154.
7. Fine, J. P., Gray R. J. A proportional hazards model for the subdistribution of a competing risk // J. Am. Stat. Assoc. – 1999. – Vol. 94. – P. 496–509.
8. Therneau, T., Grambsch, P. Modeling Survival Data: Extending the Cox Model. – Springer-Verlag, 2000. – 350p.
9. R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, URL http://www.R-project.org/. – Date of access: 21.01.2021.
10. Gray, B. (2014). cmprsk: Subdistribution Analysis of Competing Risks. R package version 2.2-7. – Mode of access: http://CRAN. R-project.org/package=cmprsk. – Date of access: 18.08.2017.
11. Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a metaanalysis of the randomized controlled trials [Electronic resourse] / J. Sun, Y. Song, Zh. Wang [et al.] // BMC Cancer. – 2012. – Vol. 12. – P. 526. – Mode of access: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC3551633/pdf/1471-2407-12-526.pdf. – Date of access: 25.10.2015.
12. Surgery combined with intraoperative hyperthermic intraperitoneal chemotherapy (IHIC) for gastric cancer: a systematic review and meta-analysis of randomized controlled trials / D. H. Mi, Zh. Li, K. H. Yang [et al.] // Int. J. Hyperthermia. – 2013. – Vol. 29. – P. 156–167.
13. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer / T. D. Yan, D. Black, P. H. Sugarbaker [et al.] // Ann. Surg. Oncol. – 2007. – Vol. 14. – P. 2702–2713.
14. Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials / F. Coccolini, E. Cotte, O. Glehen [et al.] // Eur. J. Surg. Oncol. – 2014. – Vol. 40. – P. 12–26.
15. Kim, J.-I. A controlled clinical trial of serosa-invasive gastric carcinoma patients who underwent surgery plus intra-peritoneal hyperthermo-chemo-perfusion (IHCP) / J.-I. Kim, H.-S. Bae // Gastric Cancer. – 2001. – Vol. 4. – P. 27–33.
16. Reutovich, M. Y. Efficacy of adjuvant systemic chemotherapy combined with radical surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer treatment / M. Y. Reutovich, O. V. Krasko, O. G. Sukonko // Indian J. Surg. Oncol. – 2020. – Vol. 11. – P. 337–343.