Prognosis of poorly cohesive gastric cancer after complete cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CYTO-CHIP study)

Abstract

Background The incidence of gastric poorly cohesive carcinoma (PCC) is increasing. The prognosis for patients with peritoneal metastases remains poor and the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The aim was to clarify the impact of gastric PCC with peritoneal metastases treated by CRS with or without HIPEC. Methods All patients with peritoneal metastases from gastric cancer treated with CRS with or without HIPEC, in 19 French centres, between 1989 and 2014, were identified from institutional databases. Clinicopathological characteristics and outcomes were compared between PCC and non-PCC subtypes, and the possible benefit of HIPEC was assessed. Results In total, 277 patients were included (188 PCC, 89 non-PCC). HIPEC was performed in 180 of 277 patients (65 per cent), including 124 of 188 with PCC (66 per cent). Median overall survival (OS) was 14.7 (95 per cent c.i. 12.7 to 17.3) months in the PCC group versus 21.2 (14.7 to 36.4) months in the non-PCC group (P < 0.001). In multivariable analyses, PCC (hazard ratio (HR) 1.51, 95 per cent c.i. 1.01 to 2.25; P = 0.044) was associated with poorer OS, as were pN3, Peritoneal Cancer Index (PCI), and resection with a completeness of cytoreduction score of 1, whereas HIPEC was associated with improved OS (HR 0.52; P < 0.001). The benefit of CRS-HIPEC over CRS alone was consistent, irrespective of histology, with a median OS of 16.7 versus 11.3 months (HR 0.60, 0.39 to 0.92; P = 0.018) in the PCC group, and 34.5 versus 14.3 months (HR 0.43, 0.25 to 0.75; P = 0.003) in the non-PCC group. Non-PCC and HIPEC were independently associated with improved recurrence-free survival and fewer peritoneal recurrences. In patients who underwent HIPEC, PCI values of below 7 and less than 13 were predictive of OS in PCC and non-PCC populations respectively. Conclusion In selected patients, CRS-HIPEC offers acceptable outcomes among those with gastric PCC and long survival for patients without PCC.

Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

“…46 A lower PCI score has been associated with better prognosis, and patients with limited peritoneal metastases might be appropriate candidates for cytoreductive surgery and hyperthermic intraperitoneal ChT (HIPEC); however, evidence is still limited and J o u r n a l P r e -p r o o f 10 risks must be balanced carefully against uncertain benefits. [47][48][49] The prognosis of patients with positive lavage cytology (CY+) without gross peritoneal dissemination is poor. The survival benefit of gastrectomy for these patients has not been established.…”

Impact of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer with Peritoneal Carcinomatosis: A Systematic Review and Meta-analysis

“…After the full-text reading, 7 studies were selected to be included in the qualitative synthesis 28,[31][32][33][34][35][36] and 6 in quantitative evidence syntheses 28,[32][33][34][35][36] . The Bonnot et al 37 2021 study had the same population and the same study design as one of the articles included in the meta-analysis 28 . However, it was excluded for presenting different outcomes from those considered in our eligibility criteria.…”

Integration of Genomic Biology Into Therapeutic Strategies of Gastric Cancer Peritoneal Metastasis

“…The benefits of CRS plus HIPEC need to be balanced against the risks; patients with low-volume PM (by PCI score) and possibility for CC are most likely to benefit from CRS plus HIPEC. [118][119][120][121][122] Catheter-Based Intraperitoneal Chemotherapy…”

“…CRS plus HIPEC conferred a longer median OS in this group of patients, compared with CRS alone. 119 The GASTRIPEC trial (ClinicalTrials.gov identifier: NCT02158988 ), which compared CRS plus HIPEC (with mitomycin C and cisplatin) with CRS alone with pre- and postoperative systemic chemotherapy, reported no significant difference in OS nor treatment-related adverse events. 120 Subgroup analysis demonstrated a significant improvement in OS in patients in whom complete cytoreduction (CC) was achieved in the HIPEC arm.…”