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. 2019 Aug 10;37(23):2028-2040.
doi: 10.1200/JCO.18.01688. Epub 2019 May 14.

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 , Guillaume Piessen  3 , Vahan Kepenekian  1   2 , Evelyne Decullier  4 , Marc Pocard  5 , Bernard Meunier  6 , Jean-Marc Bereder  7 , Karine Abboud  8 , Frédéric Marchal  9 , François Quenet  10 , Diane Goere  11 , Simon Msika  12 , Catherine Arvieux  13 , Nicolas Pirro  14 , Romuald Wernert  15 , Patrick Rat  16 , Johan Gagnière  17 , Jeremie H Lefevre  18 , Thomas Courvoisier  19 , Reza Kianmanesh  20 , Delphine Vaudoyer  1   2 , Michel Rivoire  21 , Pierre Meeus  21 , Guillaume Passot  1   2 , Olivier Glehen  1   2 ; FREGAT and BIG-RENAPE Networks
Affiliations

Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer With Peritoneal Metastases (CYTO-CHIP study): A Propensity Score Analysis

Pierre-Emmanuel Bonnot et al. J Clin Oncol. .

Abstract

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.

Trial registration: ClinicalTrials.gov NCT03253939.

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