中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (08): 938-944.DOI: 10.19538/j.cjps.issn1005-2208.2025.08.16

• 论著 • 上一篇    下一篇

腹腔热灌注化疗序贯含免疫治疗系统方案在胃癌腹膜转移中的转化价值研究

徐亚东1，潘宏达2，臧明德2，龙子雯2，陆    俊2，刘晓文2，刘凤林2   

  1. 1海阳市人民医院胃肠外科，山东烟台 265100；2复旦大学附属肿瘤医院胃外二科 复旦大学上海医学院肿瘤学系，上海 200032
  • 出版日期:2025-08-01 发布日期:2025-09-02

  • Online:2025-08-01 Published:2025-09-02

摘要： 目的    评估腹腔热灌注化疗（HIPEC）序贯系统治疗方案（化疗、化免联合及靶向治疗）对胃癌腹膜转移病人转化手术可行性、肿瘤应答及生存的影响。方法    采用回顾性病例系列研究设计，纳入2023年12月至2025年2月复旦大学附属肿瘤医院胃外二科收治的63例初治胃癌腹膜转移病人，所有病人均接受紫杉烷类药物为基础的HIPEC治疗。系统性治疗于HIPEC后2周内开始，每3个月定期行门诊随访及影像学评估，经多学科团队评估后决策是否实施R0切除手术。主要观察指标为治疗效果（疾病控制率、客观缓解率）、R0手术切除率和总体生存情况。结果    所有病人中，男性35例，女性28例，中位年龄55（范围27~79）岁。单纯HIPEC组4例、HIPEC序贯化疗组7例、HIPEC序贯化免组50例、HIPEC序贯化免靶组2例。所有病人整体客观缓解率为49.2%（31/63），疾病控制率达71.4%（45/63）。HIPEC序贯化免组部分缓解26例（52.0%），单纯HIPEC组25.0%，HIPEC序贯化疗组40.0%，三组比较差异无统计学意义（P=0.370）。截至随访日期，队列中共有14例（22.2%）病人达到R0切除，其中11例属于HIPEC序贯化免组，HIPEC序贯化免组接受R0切除病人治疗周期显著高于同组非转化成功病人，差异有统计学意义［（6.09±1.52）个 vs. （3.69±1.27）个，P<0.05］。全队列中位生存时间为14个月，所有R0切除病人在末次随访时均存活，而影像学进展病人的中位生存时间显著缩短至6个月。结论    基于紫杉烷类药物的HIPEC有助于改善胃癌腹膜转移病人的局部肿瘤负荷状态。采用HIPEC序贯化免联合的转化治疗策略可能为部分病人创造潜在转化手术机会，并延长生存期。

关键词: 胃癌, 腹膜转移, 腹腔热灌注化疗, 转化治疗, 联合系统治疗

Abstract: To evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) combined with systemic therapy in gastric cancer patients with peritoneal metastasis, and analyze its impact on tumor conversion and survival outcomes. Methods    A single-center retrospective study was conducted, enrolling 63 newly diagnosed gastric cancer patients with peritoneal metastasis treated at the Department of Gastric Surgery Ⅱ, Fudan University Shanghai Cancer Hospital, between December 2023 and February 2025. All patients received HIPEC treatment based on taxane drugs. Systemic chemoimmunotherapy was initiated within 2 weeks post-HIPEC, with follow-up assessments every 3 months. Multidisciplinary team evaluations determined eligibility for R0 resection. Primary outcome measures included therapeutic efficacy (disease control rate, objective response rate), R0 resection rate, and overall survival. Results    Among 63 patients ,there were 35 males and 28 females with median age at 55 (range 27-79) years. There were 4 cases in the simple HIPEC group, 7 cases in the HIPEC sequential chemotherapy group, 50 cases in the HIPEC sequential chemotherapy and immunotherapy group, and 2 cases in the HIPEC sequential chemotherapy, immunotherapy, and targeted therapy group. The overall objective response rate of all the patients was 49.2% (31/63), with a disease control rate of 71.4% (45/63). In the HIPEC sequential chemotherapy and immunotherapy group, partial remission was achieved in 26 cases (52.0%), 25.0% in the simple HIPEC group, and 40.0% in the HIPEC sequential chemotherapy group. There was no statistically significant difference between the three groups (P=0.370). By the follow-up cutoff, 14 patients (22.2%) achieved R0 resection criteria. Among them, 11 cases belonged to the HIPEC sequential chemotherapy-immunotherapy combination treatment group. The number of treatment cycles for patients who received R0 resection in the HIPEC sequential chemotherapy-immunotherapy group was significantly higher than that of patients who did not achieve conversion success in the same group, and the difference was statistically significant ［(6.09±1.52) vs. (3.69±1.27), P<0.05］. The cohort’s median survival was 14 months, with all R0 resection patients alive at last follow-up, whereas radiologically progressive patients had a median survival of 6 months. Conclusion    Paclitaxel-based HIPEC improves locoregional tumor burden in gastric cancer patients with peritoneal metastasis. The HIPEC-sequential chemoimmunotherapy strategy may create opportunities for conversion surgery and prolong survival in select patients.

Key words: gastric cancer, peritoneal metastases, hyperthermic intraperitoneal chemotherapy, conversion therapy, combined systemic therapy