Abstract:

Objective To explore the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy（HIPEC）combined with apatinib and tigio chemotherapy for conversion therapy of patients with sim⁃ ple exfoliative cytology⁃positive gastric cancer（P0CY1）. Methods Prospective study included patients with P0CY1 gastric cancer confirmed by laparoscopic exploration. All patients were treated with HIPEC combined with apatinib and tigio. The specific drugs were as follows ：three cycles of HIPEC chemotherapy were given to the patients after laparoscopic exploration（paclitaxel 75 mg/m2 ），HIPEC began to take apatinib 500 mg daily for 21 days after 14 days of paclitaxel 75 mg/m2 ），HIPEC treatment，and oral tigio 80 mg/m2 . for 14 days after laparoscopic exploration. D），was stopped for 7 days，and every 3 weeks was a course of treatment. Laparoscopic exploration was performed again after 3 cycles of conversion therapy. the main end points were the negative conversion rate of intraperitoneal free cancer cells and the resection rate of R0，while the secondary end points were total survival time（OS），progression⁃free survival time（PFS），objective remission rate（ORR），disease control rate（DCR） and safety indicators. Results From 2018⁃02⁃05 to 2018⁃12⁃31，277 patients with advanced gastric cancer were enrolled in a total of 38 patients（13.72%）with P0CY1 after laparoscopic exploration，with a median age of 54 years. After 3 cycles of conversion therapy，the ORR was 52.63%（20/38），DCR was 89.47%（34/38）. All patients underwent secondary laparoscopic exploration，and the negative conversion rate of free cancer cells in the abdominal cavity was 42.11%. All patients were resected by R0 operation. The median follow⁃up time was 16.4 months，the median survival time（mOS）was 14.9 months，the 1⁃year OS was 65.79%，the median progression ⁃free survival time（mPFS）was 11.7 months，and the 1⁃year PFS was 50.00%. The main adverse reactions of chemotherapy were Ⅰ ~Ⅱ grade hematotoxicity and digestive tract reactions，and there was no death related to conversion therapy and surgical treatment in all cases. Conclusion HIPEC chemotherapy combined with apatinib and tigio can be used as a choice of conversion therapy for patients with P0CY1 gastric cancer ，which can significantly prolong the progression⁃free survival time，and the adverse reactions of chemotherapy can be controlled. It is a safe and effec⁃ tive conversion therapy，which is worthy of further study.

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