TY - JOUR
T1 - Factors Associated with Resection and Survival After Laparoscopic HIPEC for Peritoneal Gastric Cancer Metastasis
AU - White, Michael G.
AU - Kothari, Anai
AU - Ikoma, Naruhiko
AU - Murphy, Mariela Blum
AU - Song, Shumei
AU - Ajani, Jaffer
AU - Mansfield, Paul
AU - Badgwell, Brian
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: Although laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) has been proven safe in patients with gastric adenocarcinoma and carcinomatosis or positive cytology, patient selection criteria remain unclear. Thus, we perform a retrospective analysis to identify factors associated with improved survival and resection rates. Patients and Methods: Data for all patients undergoing LS-HIPEC for stage IV gastric adenocarcinoma between June 2014 and November 2018 were collected prospectively and analyzed for associations with survival and resection using uni- and multivariate logistic regression, Cox proportional hazards models, and Kaplan–Meier survival functions. Results: Of 70 patients who underwent LS-HIPEC, 43 (61%) received two drugs (mitomycin C and cisplatin), and 27 (39%) received three drugs (mitomycin C, cisplatin, and paclitaxel). The two groups’ demographic and oncologic differences were not significant, although the three-drug group had a significantly lower rate of radiation therapy use (58% vs. 15%; p < 0.01). Univariate analysis revealed that poor differentiation [Cox hazard ratio (HR) 2.75; 95% confidence interval (CI) 1.34–5.63; p < 0.01], gross carcinomatosis (HR 3.10; 95% CI 1.52–6.30; p = 0.03), and ascites (HR 3.43; 95% CI 1.88–6.26; p < 0.01) were associated with shorter median survival. Gastrectomy was associated with improved overall survival (HR 0.32; 95% CI 0.15–0.70; p < 0.01). The resection rate of the 45 patients without ascites (38%) was significantly higher than that of the 25 patients with ascites (0%; p < 0.01). Conclusions: Our findings identify ascites as a significant prognostic factor for gastric cancer patients with peritoneal metastases undergoing LS-HIPEC. Our findings can be used to help identify patients who are unlikely to proceed to resection after LS-HIPEC and are good candidates for novel therapeutic approaches or clinical trials.
AB - Purpose: Although laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) has been proven safe in patients with gastric adenocarcinoma and carcinomatosis or positive cytology, patient selection criteria remain unclear. Thus, we perform a retrospective analysis to identify factors associated with improved survival and resection rates. Patients and Methods: Data for all patients undergoing LS-HIPEC for stage IV gastric adenocarcinoma between June 2014 and November 2018 were collected prospectively and analyzed for associations with survival and resection using uni- and multivariate logistic regression, Cox proportional hazards models, and Kaplan–Meier survival functions. Results: Of 70 patients who underwent LS-HIPEC, 43 (61%) received two drugs (mitomycin C and cisplatin), and 27 (39%) received three drugs (mitomycin C, cisplatin, and paclitaxel). The two groups’ demographic and oncologic differences were not significant, although the three-drug group had a significantly lower rate of radiation therapy use (58% vs. 15%; p < 0.01). Univariate analysis revealed that poor differentiation [Cox hazard ratio (HR) 2.75; 95% confidence interval (CI) 1.34–5.63; p < 0.01], gross carcinomatosis (HR 3.10; 95% CI 1.52–6.30; p = 0.03), and ascites (HR 3.43; 95% CI 1.88–6.26; p < 0.01) were associated with shorter median survival. Gastrectomy was associated with improved overall survival (HR 0.32; 95% CI 0.15–0.70; p < 0.01). The resection rate of the 45 patients without ascites (38%) was significantly higher than that of the 25 patients with ascites (0%; p < 0.01). Conclusions: Our findings identify ascites as a significant prognostic factor for gastric cancer patients with peritoneal metastases undergoing LS-HIPEC. Our findings can be used to help identify patients who are unlikely to proceed to resection after LS-HIPEC and are good candidates for novel therapeutic approaches or clinical trials.
UR - http://www.scopus.com/inward/record.url?scp=85087682787&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087682787&partnerID=8YFLogxK
U2 - 10.1245/s10434-020-08842-7
DO - 10.1245/s10434-020-08842-7
M3 - Article
C2 - 32648181
AN - SCOPUS:85087682787
SN - 1068-9265
VL - 27
SP - 4963
EP - 4969
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 13
ER -