Abstract Background The incidence of gastric poorly cohesive carcinoma (PCC) is increasing. The prognosis for patients with peritoneal metastases remains poor and the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The aim was to clarify the impact of gastric PCC with peritoneal metastases treated by CRS with or without HIPEC. Methods All patients with peritoneal metastases from gastric cancer treated with CRS with or without HIPEC, in 19 French centres, between 1989 and 2014, were identified from institutional databases. Clinicopathological characteristics and outcomes were compared between PCC and non-PCC subtypes, and the possible benefit of HIPEC was assessed. Results In total, 277 patients were included (188 PCC, 89 non-PCC). HIPEC was performed in 180 of 277 patients (65 per cent), including 124 of 188 with PCC (66 per cent). Median overall survival (OS) was 14.7 (95 per cent c.i. 12.7 to 17.3) months in the PCC group versus 21.2 (14.7 to 36.4) months in the non-PCC group (P < 0.001). In multivariable analyses, PCC (hazard ratio (HR) 1.51, 95 per cent c.i. 1.01 to 2.25; P = 0.044) was associated with poorer OS, as were pN3, Peritoneal Cancer Index (PCI), and resection with a completeness of cytoreduction score of 1, whereas HIPEC was associated with improved OS (HR 0.52; P < 0.001). The benefit of CRS-HIPEC over CRS alone was consistent, irrespective of histology, with a median OS of 16.7 versus 11.3 months (HR 0.60, 0.39 to 0.92; P = 0.018) in the PCC group, and 34.5 versus 14.3 months (HR 0.43, 0.25 to 0.75; P = 0.003) in the non-PCC group. Non-PCC and HIPEC were independently associated with improved recurrence-free survival and fewer peritoneal recurrences. In patients who underwent HIPEC, PCI values of below 7 and less than 13 were predictive of OS in PCC and non-PCC populations respectively. Conclusion In selected patients, CRS-HIPEC offers acceptable outcomes among those with gastric PCC and long survival for patients without PCC.

中文翻译：

---

完全细胞减灭术联合或不联合腹腔热灌注化疗后低粘性胃癌的预后（CYTO-CHIP 研究）

摘要 背景胃低粘连癌（PCC）的发病率正在增加。腹膜转移患者的预后仍然很差，细胞减灭手术（CRS）和腹腔热灌注化疗（HIPEC）的作用存在争议。目的是阐明采用或不采用 HIPEC 的 CRS 治疗胃 PCC 腹膜转移的影响。 方法1989 年至 2014 年间，在法国 19 个中心，所有接受 CRS 联合或不联合 HIPEC 治疗的胃癌腹膜转移患者均从机构数据库中确定。比较了 PCC 和非 PCC 亚型的临床病理特征和结果，并评估了 HIPEC 的可能益处。 结果总共纳入 277 名患者（188 名 PCC，89 名非 PCC）。277 名患者中有 180 名（65%）接受了 HIPEC，其中 188 名 PCC 患者中有 124 名（66%）。PCC 组的中位总生存期 (OS) 为 14.7（95% CI 12.7 至 17.3）个月，而非 PCC 组为 21.2（14.7 至 36.4）个月（P < 0.001）。在多变量分析中，PCC（风险比 (HR) 1.51，95% CI 1.01 至 2.25；P = 0.044）与较差的 OS 相关，pN3、腹膜癌指数 (PCI) 和肿瘤细胞减灭术评分完整性的切除也是如此1，而 HIPEC 与 OS 改善相关（HR 0.52；P < 0.001）。无论组织学如何，CRS-HIPEC 相对于单独 CRS 的益处是一致的，PCC 组的中位 OS 分别为 16.7 个月与 11.3 个月（HR 0.60、0.39 至 0.92；P = 0.018），以及 34.5 个月与 14.3 个月（HR 0.43）。 ，0.25 至 0.75；P = 0.003）在非 PCC 组中。非 PCC 和 HIPEC 与无复发生存率提高和腹膜复发率降低独立相关。在接受 HIPEC 的患者中，PCI 值低于 7 和低于 13 分别可预测 PCC 和非 PCC 人群的 OS。 结论在选定的患者中，CRS-HIPEC 为患有胃 PCC 的患者提供了可接受的结果，并为没有 PCC 的患者提供了较长的生存期。