DOES HIPEC IMPROVE OUTCOMES IN GASTRIC CANCER PATIENTS TREATED WITH PERIOPERATIVE CHEMOTHERAPY AND RADICAL SURGERY? A PROPENSITY-SCORE MATCHED ANALYSIS

Background: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has been associated with improved survival when compared with surgery alone for gastric cancer patients in randomized trials and meta-analyses. However, little evidence is available regarding the use of HIPEC in non-metastatic patients who are treated with perioperative chemotherapy followed by radical surgery. The aim of this study was to assess if HIPEC improved survival among gastric cancer patients treated with perioperative chemotherapy and surgery. Patients and Methods: This was a retrospective cohort study which included gastroesophageal junction (GEJ) and gastric cancer patients who were treated with perioperative chemotherapy and curative resection in a single cancer center, between 2006 and 2017. In this time period, younger patients with diffuse type tumors and serosa invasion or positive lymph node disease were offered an adjuvant HIPEC protocol. This study compared survival outcomes of these patients with those that only received perioperative chemotherapy and resection. A propensity-score 2:1 matched analysis for the two groups was also performed, and variables used were post-chemotherapy T (ypT) and N (ypN) stages, histology and tumor site. Results: The study population comprised 269 subjects, 241 treated with chemotherapy and surgery and 28 who also received HIPEC. Mean age was 59 years old and 60% of all individuals were male. A total gastrectomy was performed in 137 patients and a distal resection in 132 with a D2-lymphadenectomy in 97.4% of the sample. Overall 60-day morbidity was 35.3% and mortality was 3.3%. In the HIPEC group, 61% were females, had ASA 1-2 classification, had diffuse histology and ypN+disease. Overall survival (5-yr) results in the HIPEC and no HIPEC group were 59.5% vs. 68.7% (P=0.453), and disease-free survival ones were 49.5% and 65.8% (p=0.06), respectively. In the multivariable Cox regression model, ypT and ypN were independent overall and disease-free survival predictors; ASA 3-4 classification and diffuse histology were associated with worse overall survival. In the matched analysis, HIPEC did not improve either overall (59.5% vs. 41.0%; p=0.282) or disease-free survival (49.5% vs. 46.3%; p=0.953). Conclusion: Treatment with HIPEC in patients who received perioperative chemotherapy and a D2-resection has not improved survival outcomes. Both ypT and ypN stages remained as the most important survival predictors in this cohort.

Publication History

Article published online:
23 October 2019