2024 年第 12 期 第 0 卷

新辅助腹腔内联合全身化疗复合信迪利单抗转化治疗胃癌腹膜转移2例

Neoadjuvant intraperitoneal and systemic chemotherapy combined with sintilimab conversion therapy for peritoneal metastasis of gastric cancer: a report of 2 cases

作者：阳乐彬单汉国杨帆彭肃陈茂良王春云

英文作者：Yang Lebin Shan Hanguo Yang Fan Peng Su Chen Maoliang Wang Chunyun

单位：南华大学附属第二医院胃肠外科，衡阳421001

英文单位：Department of Gastrointestinal Surgery the Second Hospital University of South China Hengyang 421001 China

关键词：

英文关键词：Gastriccancer;Peritonealmetastasis;Neoadjuvantintraperitonealcombinedwithsystemicchemotherapy;Immunotherapy;Transformationtherapy

• 摘要：

• 腹膜转移作为进展期胃癌最常见的远处转移形式，患者预后极差。新辅助腹腔内联合全身化疗（NIPS）及以程序性细胞死亡蛋白1抑制剂为代表的免疫治疗作为新的模式，逐渐应用于胃癌腹膜转移治疗。本研究报道了2例晚期胃癌腹膜转移患者，腹腔镜探查提示腹膜转移，予以奥沙利铂+替吉奥联合白蛋白结合型紫杉醇全身及腹腔化疗、信迪利单抗静脉输注治疗4个周期。转化治疗后患者影像学提示部分缓解，再行腹腔镜探查术，探查中未见明确腹膜转移病灶，成功实施根治性切除手术，术后病理提示有效降期，患者恢复顺利，随访期间患者生活质量极大改善。表明NIPS联合信迪利单抗转化治疗模式用于胃癌腹膜转移转化治疗效果良好、安全性可，但此模式尚需更多研究论证。

• Peritoneal metastasis in advanced gastric cancer is the most common form of distant metastasis in patients with poor prognosis. Neoadjuvant intraperitoneal combined with systemic chemotherapy (NIPS) and immunotherapy represented by programmed cell death protein 1 inhibitors have been gradually applied to the treatment of peritoneal metastasis of gastric cancer. In this study, two patients with advanced gastric cancer with peritoneal metastasis were reported. Laparoscopic exploration indicated peritoneal metastasis, and they were treated with oxaliplatin and tegafur, gimeracil and oteracil potassium combined with albumin-bound paclitaxel systemic and intraperitoneal chemotherapy, and sintilimab intravenous infusion for 4 cycles. After conversion therapy, the patient′s imaging showed partial remission, and then laparoscopic exploration was performed, and no clear peritoneal metastasis was found in the exploration. The radical resection was successfully performed, and the postoperative pathology showed effective downstaging, and the patient recovered smoothly. The results indicate that NIPS combined with sintilimab is effective and safe in the conversion therapy of gastric cancer with peritoneal metastasis, but this mode needs more research to prove.