Efficacy And Safety Of Hyperthermic Intraperitoneal Chemotherapy Combined With Immunotherapy And Systemic Chemotherapy In The Treatment Of Advanced Gastric Cancer With Peritoneal Metastasis

Objective:The overall prognosis of advanced gastric cancer,especially patients with peritoneal metastasis,is poor,and there is no standardized treatment plan.The purpose of this study was to retrospectively observe the efficacy,survival data and safety of hyperthermic intraperitoneal chemotherapy(HIPEC)combined with immunotherapy(IO)and systemic chemotherapy(SC)triple therapy in first-line treatment of advanced gastric cancer patients with peritoneal metastasis compared with IO combined with SC double therapy,and to analyze whether triple therapy can bring clinical benefits to such advanced gastric cancer patients.To provide evidence-based medical evidence for clinical treatment.Methods:In this study,advanced gastric cancer patients with peritoneal metastasis admitted to the First Affiliated Hospital of Nanchang University from June31,2019 to June 31,2022 were selected,and a total of 64 patients were screened out according to the inclusion and exclusion criteria.The patients were divided into HIPEC+IO+SC group(n=35)and IO+SC group(n=29)according to whether the first-line treatment was combined with HIPEC or not.Clinical data of patients were collected by consulting medical records,outpatient follow-up and telephone follow-up,and general data of patients in the two groups were compared:including sex,age,body mass index(BMI),Barthle index score,previous history,smoking,alcohol consumption,pathological type,differentiation degree,Borrmann classification,Lauren classification,distant metastasis,CEA value,CA12-5 value,CA19-9 value;Short-term efficacy indicators:included complete response(CR),partial response(PR),progression disease(PD),stable disease(SD),objective response rate(ORR),disease control rate(DCR),rate of successful transformation and radical surgery;Survival measures:included median progression-free survival(m PFS),median overall survival(m OS)and systemic adverse reactions.IBM SPSS 24.0 statistical software was used to analyze all the collected data.The counting data was represented by the number of cases(%).The comparison between the two groups was conducted byX~2 test or correctedX~2 test.Measurement data were expressed as mean±standard deviation((?)±S),and comparison between the two groups was performed by T-test or corrected T-test,p<0.05 was considered statistically significant.Kaplan-Meier method was used to draw the survival curve to describe the survival process.Comparison of survival time distribution between groups was tested by Log-rank method.COX regression was used to further analyze the factors that may be clinically influential on survival time.Results:There was no significant difference in the general data between the two groups(p>0.05),indicating comparability.In the first-line treatment of advanced gastric cancer with peritoneal metastasis,HIPEC+IO+SC triple therapy increased SD(31.4%vs 6.9%,p<0.05),prolonged m PFS(6.2 months vs 4.4 months,p<0.05)and m OS(10.1 months vs 8.6 months,p<0.05)compared with IO+SC double therapy.There was no significant difference in ORR(45.7%vs 58.6%)and DCR(77.1%vs65.5%)between the two groups after three cycles of treatment(p>0.05).There were 7and 3 cases(20%vs 10.3%)in the two groups respectively with no statistical significance(p>0.05).Multivariate COX regression analysis of HIPEC+IO+SC group showed that CEA had a statistically significant effect on survival time(HR=0.762,95%CI 0.624-0.931,p=0.008).The effect of CA12-5 on survival time was statistically significant(HR=0.567,95%CI 0.328-0.752,p=0.014).There was no statistical significance in the adverse reactions of the two therapies to each system of patients(p>0.05).Conclusion:Compared with IO+SC combination therapy,HIPEC+IO+SC triple therapy is the first-line therapy for advanced GC patients with PM,which can effectively increase SD,prolong m PFS and m OS.However,there was no statistic difference in improving short-term ORR、DCR and the rate of successful transformation after treatment and receiving radical surgical treatment.CEA and CA12-5 values had statistically significant effects on survival time.The addition of HIPEC will not increase the incidence of adverse reactions in patients,and the overall safety is controllable.