Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastases (CYTO-CHIP study): A propensity score analysis
Pierre-Emmanuel Bonnot
(1, 2, 3)
,
Guillaume Piessen
(4, 5, 6)
,
Vahan Kepenekian
(7, 1)
,
Evelyne Decullier
(8)
,
Marc Pocard
(9, 10)
,
Bernard Meunier
(11)
,
Jean-Marc Bereder
(12)
,
Karine Abboud
(13)
,
Frédéric Marchal
(14, 15)
,
François Quenet
(16, 17)
,
Diane Goere
(18)
,
Simon Msika
(19)
,
Catherine Arvieux
(20)
,
Nicolas Pirro
(21)
,
Romuald Wernert
(22)
,
Patrick Rat
(23)
,
Johan Gagnière
(24)
,
Jeremie Lefevre
(25)
,
Thomas Courvoisier
(26)
,
Reza Kianmanesh
(27)
,
Delphine Vaudoyer
(28)
,
Michel Rivoire
(29)
,
Pierre Meeus
(29)
,
Guillaume Passot
(28)
,
Olivier Glehen
(28)
1
EA3738 -
Ciblage thérapeutique en Oncologie
2 UCBL - Université Claude Bernard Lyon 1
3 Surgical Department [Lyon]
4 Hôpital Claude Huriez [Lille]
5 CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
6 JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837
7 Centre Hospitalier Lyon Sud [CHU - HCL] CHLS - Service de Chirurgie Viscérale et Oncologique
8 IMER - Pôle Information Médicale Evaluation Recherche
9 CART U965 - Carcinose Angiogenèse et Recherche Translationnelle ; Angiogenese et recherche translationnelle
10 Hôpital Lariboisière-Fernand-Widal [APHP]
11 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
12 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
13 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
14 CRAN - Centre de Recherche en Automatique de Nancy
15 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
16 Département de chirurgie
17 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
18 Département de chirurgie générale [Gustave Roussy]
19 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
20 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
21 Hôpitaux Sud - Hôpital Sainte-Marguerite [CHU - APHM]
22 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
23 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
24 CHU Clermont-Ferrand
25 ICGM - Institut Charles Gerhardt Montpellier - Institut de Chimie Moléculaire et des Matériaux de Montpellier
26 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
27 CHU Reims - Hôpital universitaire Robert Debré [Reims]
28 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
29 Centre Léon Bérard [Lyon]
2 UCBL - Université Claude Bernard Lyon 1
3 Surgical Department [Lyon]
4 Hôpital Claude Huriez [Lille]
5 CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
6 JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837
7 Centre Hospitalier Lyon Sud [CHU - HCL] CHLS - Service de Chirurgie Viscérale et Oncologique
8 IMER - Pôle Information Médicale Evaluation Recherche
9 CART U965 - Carcinose Angiogenèse et Recherche Translationnelle ; Angiogenese et recherche translationnelle
10 Hôpital Lariboisière-Fernand-Widal [APHP]
11 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
12 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
13 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
14 CRAN - Centre de Recherche en Automatique de Nancy
15 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
16 Département de chirurgie
17 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
18 Département de chirurgie générale [Gustave Roussy]
19 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
20 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
21 Hôpitaux Sud - Hôpital Sainte-Marguerite [CHU - APHM]
22 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
23 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
24 CHU Clermont-Ferrand
25 ICGM - Institut Charles Gerhardt Montpellier - Institut de Chimie Moléculaire et des Matériaux de Montpellier
26 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
27 CHU Reims - Hôpital universitaire Robert Debré [Reims]
28 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
29 Centre Léon Bérard [Lyon]
Evelyne Decullier
- Fonction : Auteur
- PersonId : 760339
- ORCID : 0000-0002-2412-4767
- IdRef : 092909590
Frédéric Marchal
- Fonction : Auteur
- PersonId : 806992
- ORCID : 0000-0002-7685-6070
Olivier Glehen
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- Fonction : Auteur correspondant
- PersonId : 1359956
- ORCID : 0000-0002-2802-4974
- IdRef : 120001845
Connectez-vous pour contacter l'auteur
Résumé
PURPOSE Gastric cancer (GC) with peritoneal metastases (PMs) is a poor prognostic evolution. Cytoreductive surgery (CRS) yields promising results, but the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. Here we aimed to compare outcomes between CRS-HIPEC versus CRS alone (CRSa) among patients with PMs from GC. PATIENTS AND METHODS From prospective databases, we identified 277 patients with PMs from GC who were treated with complete CRS with curative intent (no residual nodules > 2.5 mm) at 19 French centers from 1989 to 2014. Of these patients, 180 underwent CRS-HIPEC and 97 CRSa. Tumor burden was assessed using the peritoneal cancer index. A Cox proportional hazards regression model with inverse probability of treatment weighting (IPTW) based on propensity score was used to assess the effect of HIPEC and account for confounding factors. RESULTS After IPTW adjustment, the groups were similar, except that median peritoneal cancer index remained higher in the CRS-HIPEC group (6 v 2; P = .003). CRS-HIPEC improved overall survival (OS) in both crude and IPTW models. Upon IPTW analysis, in CRS-HIPEC and CRSa groups, median OS was 18.8 versus 12.1 months, 3- and 5-year OS rates were 26.21% and 19.87% versus 10.82% and 6.43% (adjusted hazard ratio, 0.60; 95% CI, 0.42 to 0.86; P = .005), and 3- and 5-year recurrence-free survival rates were 20.40% and 17.05% versus 5.87% and 3.76% ( P = .001), respectively; the groups did not differ regarding 90-day mortality (7.4% v 10.1%, respectively; P = .820) or major complication rate (53.7% v 55.3%, respectively; P = .496). CONCLUSION Compared with CRSa, CRS-HIPEC improved OS and recurrence-free survival, without additional morbidity or mortality. When complete CRS is possible, CRS-HIPEC may be considered a valuable therapy for strictly selected patients with limited PMs from GC.