| Objective:To explore the clinical effect of adjuvant Intraperitoneal Perfusion Chemotherapy (IPC) on postoperative patients with gastric carcer .Methods: Three hundred and sixty patients with gastric cancer who diagnosed and treated between January 2001 and December 2005 at Fujian Provincial Tumor Hospital were included in the study. Patients were classified into IP+ and IP- groups. The IP+ group contained patients who received systemic adjuvant chemotherapy with IPC after gastric resection, and IP- group were patients who received systemic adjuvant chemotherapy without IPC after gastric resection. Neither radiotherapy nor targeted therapy was given to any patients. The clinical efficacy and the situation of relapse and metastasis were followuply analyzed. And the benefit crowds, the number and time of IPC were further stratified analyzed.Results:The median follow-up time of the 360 cases of adjuvant therapy of gastric cancer was 49.9 months. The average overall survival(OS)in IP+ patients was 66.7 months, verse 56.5months in the IP- group,(P=0.004). There was no statistically significant difference in one and three year OS, but a highly statistically significant difference in 5-year OS (P=0.001). The average disease free-survival (DFS) in IP+ patients was significantly longer (P=0.01) 60.5 months, verse 46.2 months in IP- patients. There were statistically significant differences in the one, three and five year DFS(P<0.05).Further subgroup analysis indicates that Curative resection, a histological type other than mucinous adenocarcinoma and signet ring cell carcinoma, lower-Undifferentiated tumor grade , pathologic stages IIB,IIIA,Lymph node metastasis N1-3,Depth of invasion T2,T3+T4a showed statistically significant in OS and DFS between the two groups .The analysis of relapse and metastasis between the two groups showed that the rates of peritoneal carcinomatosis, celiac lymph node and hepatic metastasis in the IP+ patients was significantly lower than in the IP- patients.There were no significant differences in grade III and IV toxicity between the IP+ and IP- groups, except for more patients with leukopenia in the IP+ patients(20.65% v 7.95%,P=0.001).We analyzed the number of cycles and time of start of IPC impact on OS and DFS to the 184 patients in the IP+ group. The research to the number of cycles showed that the median number of cycles were 5 cycles The patients who received more than 6 cycles and 3 to 6 cycles of IPC had a significantly better OS and DFS. There was no difference in OS and DFS between the two groups who received more than 6 cycles and 3 to 6 perfusions. The median time after surgery that patients started IPC was 33 days. Average OS and PFS for the patients who started IPC earlier than 30 days were significantly better than those who started after 60 days; OS P=0.009 and PFS P=0.038. There was no difference between patients who started IPC after 60 days and those who started between 30-60 days, nor was there any difference between patients who started IPC between 30-60 days and earlier than 30 days.Conclusion: This study showed that adjuvant IPC for resectable gastric cancer could decrease the rates of peritoneal carcinomatosis, celiac lymph node and hepatic metastasis and improve OS and DFS. The patients with curative resection, a histological type other than mucinous adenocarcinoma and signet ring cell carcinoma, low and undifferentiated tumor grade, lymph node metastasis, and T3 and T4a benefited from IPC. The patients who received fewer than 3 cycles of IPC and more than 6 perfusions could gain a significant advantage of survival. ObjectionThis study evaluated the efficacy and safety of adjuvant intraperitoneal perfusion chemotherapy(IPC) in resectable gastric cancer through retrospective analysis.Methods360 T2-4bN0-3M0 resectable gastric cancer patients were included in this study. 184 (IP+) used systemic chemotherapy combined IPC and 176 (IP-)systemic chemotherapy only.ResultsWith a median of 49.9months follow up, the 5-year OS in IP+ was significantly better than IP- (60.4% verse 42.9%, P=0.001) and the average PFS in IP+ patients was significantly longer than IP-(60.5 months verse 46.2months, P=0.001).Relapse rates of peritoneal carcinomatosis, celiac lymph node and hepatic metastasis in the IP+ patients were significantly lower than in the IP- patients. Patients with curative resection, a histological type other than mucinous adenocarcinoma and signet ring cell carcinoma, low and undifferentiated tumor grade, lymph node metastasis, andT3 and T4a benefited from adjuvant IPC. The toxicity were the same except for more patients with leukopenia in the IP+(P=0.001). The number of cycles of IPC and the time of start of IPC after surgery impact OS and DFS.ConclusionAdjuvant IPC for resectable gastric cancer gave encouraging results and large multicenter prospective randomized controlled studies are warrant.
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