Efficacy analysis of intraperitoneal perfusion combined with intravenous and oral three-way chemotherapy in the treatment of gastric cancer with peritoneal metastasis / 中国综合临床

ABSTRACT

Objective:To investigate the efficacy of peritoneal perfusion combined with intravenous and oral chemotherapy in the treatment of gastric cancer with peritoneal metastasis and its correlation with prognosis.Methods:The clinical data of 142 patients with peritoneal metastasis of gastric cancer admitted to the Affiliated Hospital of Xuzhou Medical University from March 2012 to June 2019 were retrospectively analyzed.According to different treatment schemes, the patients were divided into observation group (47 cases treated with tegafur capsule orally+ docetaxel+ cisplatin combined with recombinant human tumor necrosis factor intraperitoneal perfusion) and control group (oral administration of tegafur capsule+ oxaliplatin). The clinical efficacy and prognostic factors were compared between the two groups.Results:The short-term efficacy after two courses of chemotherapy the effective rate was 44.7% (21/47) in the observation group and 8.4% (8/95) in the control group, the difference was statistically significant (χ 2=25.438, P<0.001); the disease control rate was 97.9% (46/47) in the observation group and 60.0% (57/95) in the control group, the difference was statistically significant (χ 2=22.639, P<0.001). Long term efficacy the progression free survival time of the observation group was higher than that of the control group (6.50 months vs.3.83 months, χ 2=16.399, P<0.001); the total survival time of the observation group was higher than that of the control group (15.60 months vs.10.83 months, χ 2=9.219, P=0.002). Univariate analysis showed that ascites volume, chemotherapy, palliative surgery, liver metastasis, Lauren classification and Her-2 expression were related to prognosis (all P<0.05); there was no significant difference in cumulative survival rate of different gender, age and ECOG score (all P>0.05). Multivariate analysis showed that liver metastasis ( HR=1.996, 95% CI=1.194-3.338, P=0.008 ), Lauren type ( HR=1.979, 95% CI=1.265-3.094, P=0.003 ), Her-2 expression ( HR=3.872, 95% CI=2.202-6.808, P<0.001 ), chemotherapy regimens(whether combined with intraperitoneal chemotherapy) ( HR=1.826, 95% CI=1.046-3.188, P=0.034 ) and abdomina volume ( HR=2.785, 95% CI=1.644-4.718, P<0.001 ) were independent risk factor for the prognosis of patients. Conclusion:Intraperitoneal perfusion combined with intravenous and oral administration has a good clinical effect in the treatment of peritoneal metastasis of gastric cancer, which can effectively improve the clinical symptoms and improve the survival rate of patients.The presence or absence of liver metastasis, Lauren classification, Her-2 expression, chemotherapy method (combined with intraperitoneal perfusion or not) and ascites volume are independent risk factors for the prognosis of peritoneal metastasis of gastric cancer.