Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching

Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching Chenbin Lv, Lin-Yan Tong, Wei-Ming Zeng, Qiu-Xian Chen, Shun-Yong Fang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4461027/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Sep, 2024 Read the published version in World Journal of Surgical Oncology → Version 1 posted 17 You are reading this latest preprint version Abstract Background Clinical T4 (cT4) stage gastric cancer presents with frequent postoperative recurrence and poor prognosis. This study is to evaluate the oncological efficacy of laparoscopic radical total gastrectomy combined with postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with cT4N + M0 gastric cancer who received neoadjuvant chemotherapy. Methods We reviewed the clinicopathological data of 174 patients with clinical T4 gastric cancer who underwent neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy between June 2017 and December 2021. Among them, 142 were included in the non-HIPEC group, and 32 in the HIPEC group. Patients in both groups were paired based on propensity score in a 2:1 ratio to assess disparities in tumor recurrence and long-term survival. Results After matching, there were no significant differences in the clinicopathological data between the two groups. The peritoneum (16.1%) and distant organs (10.9%) were the most frequent locations for recurrence. Prior to matching, the recurrence rates were similar at all sites for both groups. Compared with those in the non-HIPEC cohort, the recurrence rates at all sites, the lung, and the peritoneum were notably lower in the HIPEC cohort. Prior to matching, the 3-year overall survival and disease-free survival rates were similar between the two groups; following matching, the HIPEC group exhibited notably greater survival rates than did the non-HIPEC group. The disparities in survival rates between the groups became even more pronounced after conducting a stratified analysis among patients with stage III disease. Conclusions Neoadjuvant chemotherapy combined with prophylactic HIPEC after laparoscopic radical gastrectomy can effectively reduce the rate of peritoneal metastasis in patients with cT4N + M0 advanced gastric cancer and significantly improve the prognosis of such patients, which is of great clinical value. neoadjuvant chemotherapy laparoscopic surgery hyperthermic intraperitoneal chemotherapy gastric cancer Figures Figure 1 Figure 2 Figure 3 Introduction Gastric cancer is a prevalent type of cancer globally, with high rates of occurrence and death, ranking fifth and fourth in terms of malignant tumors, respectively [ 1 ]. Despite radical surgery being the primary and most efficient treatment for gastric cancer, approximately 70% of patients still experience recurrence and metastasis after surgery, particularly those with cT4 gastric cancer [ 2 , 3 ]. Multiple research studies indicate that neoadjuvant chemotherapy has the potential to lower the likelihood of postoperative recurrence and metastasis and enhance the outlook for individuals diagnosed with advanced gastric cancer [ 4 – 6 ]. Nevertheless, the prognosis for patients with advanced gastric cancer remains poor, with the recurrence rate of peritoneal implantation metastasis after radical gastrectomy ranging from 35–50%, making it the primary mode of recurrence for gastric cancer [ 3 , 7 – 9 ]. Hence, preventing peritoneal metastasis following radical gastrectomy is crucial. HIPEC can successfully prevent peritoneal metastasis in gastric cancer patients by administering chemotherapy drugs directly into the abdomen and utilizing high temperatures to eliminate cancer cells. Several research studies indicate that HIPEC can be beneficial for reducing peritoneal metastasis and increasing the survival rate of individuals diagnosed with late-stage gastric cancer [ 10 – 13 ]. For cT4 gastric cancer patients, who have a high risk of postoperative recurrence and peritoneal metastasis, laparoscopic surgery after neoadjuvant chemotherapy allows patients to benefit from minimally invasive surgery while receiving standardized gastric cancer treatment. Combined with postoperative prophylactic HIPEC, this approach is expected to improve patient prognosis [ 11 , 13 ]. In this research, we utilized propensity score matching to assess the effectiveness of neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy along with postoperative HIPEC for preventing cancer in individuals with cT4N + M0 gastric cancer by contrasting the recurrence rates, 3-year overall survival (OS), and disease-free survival (DFS) among the non-HIPEC and prophylactic HIPEC groups. Methods Patients This study analyzed the medical records of 223 patients diagnosed with cT4N + M0 gastric cancer who underwent laparoscopic total gastrectomy following neoadjuvant chemotherapy at Zhangzhou Hospital, Fujian Medical University's Department of Gastric Surgery, from June 2017 to December 2021. The inclusion criteria were patients with advanced tumors who were staged as T4a-b, N+, or M0 on preoperative imaging; aged 18–75 years; pathologically diagnosed with gastric adenocarcinoma; provided informed consent; and underwent laparoscopic radical total gastrectomy and standardized D2 lymph node dissection. Exclusion criteria included preoperative or intraoperative identification of peritoneal and distant spread of cancer, incomplete resection, contraindications to HIPEC or systemic chemotherapy drugs, previous malignancies within the past 5 years, and the need for simultaneous surgery for other conditions. The 174 eligible patients were categorized into two groups based on whether postoperative HIPEC was conducted: a non-HIPEC group consisting of 142 patients and a HIPEC group consisting of 32 patients. To make the data of the two groups comparable, age, sex, and tumor stage were utilized as matching criteria, and the propensity score technique was employed to pair the two groups at a ratio of 1:2, with a caliper threshold of 0.2. A total of 80 patients were divided into two groups: 29 in the HIPEC group and 51 in the non-HIPEC group, as shown in Fig. 1 . This retrospective study was approved by the Ethics Committee of Zhangzhou Hospital Affiliated with Fujian Medical University. All patients underwent standard preoperative tests, such as CT scans of the chest and abdomen and tumor marker analysis; additional imaging, such as positron emission tomography (PET)-CT and bone scans, was performed as needed to check for distant spread of the cancer. The stage of gastric cancer was classified according to the 8th edition of the American Joint Committee on Cancer (AJCC) on Cancer Staging System [ 14 ]. Surgical methods and HIPEC procedure An identical team of surgeons conducted every surgery, with each patient receiving laparoscopic radical total gastrectomy with D2 lymphadenectomy following the 2010 3rd edition of the Japanese Guidelines for Gastric Cancer Treatment [ 15 ]. The patient was positioned lying on their back with their legs apart, and a small tube was inserted below the belly button for observation; a larger tube was inserted 2 cm below the rib on the left side for the main procedure; and smaller tubes were inserted on the right side below the rib and above the belly button on both sides for additional procedures, with a pressure of 12 mmHg in the abdomen. The surgeon stood to the left of the patient, the assistant to the right, and a mirror holder was positioned between the patient's legs. D2 lymph node dissection was carried out, with the specific steps of the dissection being documented in a previous publication [ 16 ]. Total gastrectomy was performed with esophagus-jejunum Roux-en-Y digestive tract reconstruction. In the HIPEC group, approximately 3 weeks postsurgery, a 16-gauge needle guided by a color ultrasound was used to perform left upper and right lower abdominal punctures and catheterizations in the treatment room next to the bed. Hyperthermic perfusion and circulation were performed using a HIPEC machine (China, Model: HGGZ-102). The perfusion solution was consistently introduced and removed from the abdominal cavity at a steady temperature, rate, and quantity. The prophylactic HIPEC regimen consisted of 80 mg of docetaxel (60 min, 42 ± 1°C). The perfusion fluid was a mixture of normal saline and docetaxel at a dose of 3000–5000 ml. The circulation flow rate was 300–500 ml/min, and a total of 1–3 courses were administered according to the patient's tolerance, with an interval of 48 h between treatments. During the perfusion process, the patient was instructed to turn over appropriately from side to side to allow the drug to fully contact the peritoneum and enhance its therapeutic effect. Perioperative chemotherapy scheme and cycle All individuals were treated with neoadjuvant chemotherapy followed by postoperative adjuvant chemotherapy using the SOX (Oxaliplatin and S-1) or XELOX (Oxaliplatin and Capecitabine) regimen [ 17 ]. The patients received 2–4 cycles of chemotherapy before surgery and 4–6 cycles of chemotherapy after surgery. The HIPEC team began administering standard chemotherapy 48 hours post-HIPEC, while the control group initiated their first chemotherapy treatment 3 to 4 weeks postsurgery. Postoperative follow-up Postoperative follow-ups were conducted by a dedicated person through outpatient visits, home visits and telephone calls. Follow-up assessments were performed every quarter for the first 2 years and then biannually for the following 3–5 years. The majority of patients received standard physical check-ups, blood tests (such as CA19-9 and CEA levels), chest X-rays, full abdominal ultrasounds or CT scans, and yearly gastroscopies. The OS time was recorded from the time of surgery to the last follow-up, death, or the time when the follow-up database was closed (such as loss to follow-up or death from other diseases). Disease-free survival (DFS) was determined from the date of the surgical procedure until the occurrence of tumor recurrence or mortality. Local recurrence or distant metastasis confirmed by imaging or pathology was considered tumor recurrence, and the site of recurrence was determined based on the earliest location of the finding. Statistical analysis Statistical analysis was performed using the R4.1.0 software packages “MatchIt” and “foreign” and SPSS 26.0 statistical software. The χ2 test was used for analyzing the categorical data; the measurement data are expressed as χ ± S. Categorical data were examined with either the χ2 test or Fisher's exact test, whereas numerical data were assessed using the t test. Data that did not follow a normal distribution were examined with the Mann‒Whitney test. Survival rates were calculated with the Kaplan–Meier method, and the log-rank test was used to compare differences between the two groups. Statistical significance was set at P < 0.05. Results Comparison of clinicopathologic characteristics between the two groups before and after matching The general clinicopathological characteristics of the entire group of patients are shown in Table 1 . Prior to matching, the percentage of individuals with neurovascular invasion, tumor differentiation G2-3, diffuse type Lauren staging, pT staging 3–4, pN staging 2–3, and postoperative pathology of Stage II–III in the HIPEC cohort was notably greater than that in the non-HIPEC cohort. Following the matching process, there were no notable variations in the clinicopathological information of the patients within the two groups, as shown in Table 1 . Comparison of postoperative recurrence between the two groups The peritoneum was the most frequent location for recurrent metastasis in all patients, with distant organs, distant lymph nodes, localized regions, and bone metastases following a decreasing order of prevalence. In the prematched HIPEC group, the total percentage of patients who experienced recurrence was 34.4%, which was less than the percentage in the non-HIPEC group (45.8%), although the difference was not statistically significant. Patients in both groups had similar rates of local recurrence, peritoneal recurrence, and distant metastasis at all locations. The HIPEC group had notably lower recurrence rates at all sites (27.6% vs. 58.2%, P = 0.07) and in the lung (0.0% vs. 7.8%, P = 0.112) and peritoneum (6.9% vs. 25.5%, P = 0.041) than did the non-HIPEC group, as shown in Table 2. Comparison of survival between the two groups The duration of the follow-up was prolonged until December 2023, with a median follow-up period of 49 months (ranging from 15 to 78 months) for the entire cohort. Prior to comparison, the 3-year overall survival and disease-free survival rates of the HIPEC cohort were similar to those of the non-HIPEC cohort (Fig. 2 A and B). According to the comparison, the 3-year overall survival rate for the HIPEC cohort was 63.2%, which was a notable increase compared to that of the non-HIPEC group (38.5%), despite the lack of statistical significance (P = 0.073; Fig. 3 A). The three-year disease-free survival rate in the HIPEC cohort was significantly greater than that in the non-HIPEC cohort (59.0% vs. 35.2%, P = 0.033), as shown in Fig. 3 B. Comparison of survival between the two groups of stage III patients After stratification by postoperative pathological stage and matching, compared with the non-HIPEC cohort, the HIPEC cohort exhibited superior 3-year OS (62.4% vs. 34.8%, P = 0.077) and DFS (47.4% vs. 20.4%, P = 0.022) (Fig. 3 C and D). Discussion The general enhancement in the outlook for gastric cancer is not substantial. One of the main reasons for this is the high proportion of patients with advanced disease at the time of diagnosis. In China, the number of early gastric cancer cases is 20%, and locally advanced gastric cancer cases account for 70% [ 18 ]. Neoadjuvant chemotherapy has become increasingly common for treating locally advanced gastric cancer in recent years due to its ability to decrease tumor size and stage and enhance the rate of surgical resection, particularly for cT4 patients [ 4 , 5 ]. Furthermore, advancements in laparoscopic tools and the enhanced skills of surgeons have led to increased interest in the use of neoadjuvant chemotherapy alongside radical gastrectomy for treating locally advanced gastric cancer [ 19 ]. Recent research indicates that laparoscopic D2 radical gastrectomy offers specific benefits in managing advanced gastric cancer [ 20 ]. Even with neoadjuvant chemotherapy, laparoscopic surgery is still considered safe and dependable compared to open surgery, with no significant impact on the occurrence or death rate of perioperative complications [ 21 ]. Despite the need for radical surgery, peritoneal metastasis remains the most common and earliest form of disease progression in patients with gastric cancer [ 3 , 7 , 8 ]. Approximately 50% of patients develop peritoneal metastasis after surgery, with an extremely poor prognosis[ 9 ]. The best combination of multimodal treatments, such as HIPEC in adjuvant therapy, is being explored to prevent peritoneal metastasis in gastric cancer patients. The application of therapeutic HIPEC has been recognized in patients who have developed peritoneal metastasis [ 22 ]. Nevertheless, the effectiveness of preventive HIPEC in decreasing the incidence of peritoneal metastasis in gastric cancer patients with high-risk factors such as stage T4 disease is still under investigation. A meta-analysis involving 32 nonrandomized controlled trials (2520 patients) revealed that radical surgery with HIPEC was effective at reducing the risk of peritoneal metastasis (RR = 0.63, 95% CI 0.45–0.88; P < 0.01)[ 23 ]. An analysis of the clinical and pathological information of 132 patients with cT4 gastric cancer performed by Lee et al. [ 11 ] revealed that undergoing radical gastrectomy along with early postoperative prophylactic HIPEC could lower the occurrence of peritoneal metastasis, although it did not affect the rate of distant metastasis. A phase II clinical study conducted by Fan et al. [ 24 ] revealed that radical gastrectomy combined with cisplatin HIPEC did not reduce the recurrence rate of peritoneal metastasis. However, in most studies, HIPEC was performed under general anesthesia with thicker catheters placed during the operation, especially during or immediately after the operation, and only one treatment was performed, which may pose some risks [ 25 ]. Modified HIPEC treatment under bedside ultrasound guidance requires only local anesthesia and the use of thinner catheters, which is well tolerated, safe, and repetitive in patients [ 13 ]. In a study involving patients with stage III gastric cancer, researchers utilized bedside-adapted HIPEC and discovered that administering prophylactic HIPEC after surgery decreased the chances of ovarian (7.0% vs. 0.0%) and peritoneal metastasis (21.1% vs. 10.5%, P = 0.198). However, there was no significant difference in metastasis to other locations (such as the lung, bone, brain, liver, or abdominal lymph nodes) between the two groups. The research indicated that administering prophylactic HIPEC at the bedside after surgery notably decreased the occurrence of peritoneal recurrence in individuals with cT4 stomach cancer (6.9% vs. 25.5%, P = 0.041). Nevertheless, the outcome for individuals with cT4 stomach cancer following prophylactic HIPEC surgery is still uncertain. Previous studies revealed that administering postoperative prophylactic HIPEC enhanced long-term survival outcomes for patients diagnosed with late-stage gastric cancer [ 10 , 26 ]. According to a study by Allievi et al. [ 27 ], HIPEC increased the 1- and 3-year OS and DFS rates for patients with advanced gastric cancer at high risk of recurrence. A multicenter prospective clinical study indicated no difference in OS between the HIPEC and non-HIPEC groups, while DFS was significantly better in the HIPEC group [ 28 ]. On the other hand, Diniz and colleagues [ 29 ] reported that HIPEC treatment did not improve patient prognosis. A real-world retrospective study from China also showed no survival benefit for gastric cancer patients who underwent HIPEC (P = 0.220 for OS and P = 0.370 for cancer-specific survival) [ 30 ]. In this study, the 3-year OS and DFS rates in the HIPEC group were greater than those in the non-HIPEC group. HIPEC significantly enhanced the 3-year overall survival (62.4% vs. 34.8%, P = 0.077) and disease-free survival (47.4% vs. 20.4%, P = 0.022) rates, especially in patients with stage III cancer following neoadjuvant chemotherapy. Liu et al.[ 13 ] also showed that the middle DFS (29 compared to 15 months, P = 0.006) and OS (42 compared to 31 months, P = 0.042) in the HIPEC category were notably greater than those in the non-HIPEC category. Hence, effective treatments for advanced-stage T4 gastric cancer require a combination of therapies and ongoing optimization. There were certain limitations in this research. This was a single-center retrospective study, which may have led to bias. Hence, we employed propensity score matching to reduce selection bias, enhancing comparability between the two groups and increasing the accuracy of the results. Second, the sample size was small, and the long-term oncologic outcomes of neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy and postoperative preventive HIPEC need to be confirmed in large-sample, multicenter, randomized controlled studies. In conclusion, our study suggested that postoperative prophylactic HIPEC can reduce the rate of peritoneal metastasis in patients with cT4N + M0 advanced gastric cancer and improve the prognosis of such patients. Abbreviations cT stage Clinical T stage HIPEC Hyperthermic intraperitoneal chemotherapy pT stage Pathological T stage pN stage Pathological N stage CT Computed tomography PET Positron emission tomography AJCC American Joint Committee on Cancer DFS Disease-free survival OS Overall survival BMI Body mass index ASA American society of anesthesiologists physical status classification SOX Oxaliplatin and S-1 XELOX Oxaliplatin and Capecitabine Declarations Acknowledgments We express gratitude to the individuals who contributed significantly to this research, such as nurses, pathologists, postgraduate physicians, data analysts, peer reviewers, and editorial staff. They did not receive any financial compensation for the work they did. Author contributions Chen-Bin Lv, Lin-yan Tong, and Wei-Ming Zeng conceived the study, analyzed the data, and drafted the manuscript. Li-Sheng Cai helped critically revise the manuscript for important intellectual content. Qiu-Xian Chen, Shun-Yong Fang, and Yu-Qin Sun helped collect the data and design the study. All the authors have reviewed and approved the final manuscript. Funding Statement Funding for this research was provided by the Startup Fund for Scientific Research at Fujian Medical University (2018QH1214) and the Climbing Fund for PhD Workstation at Zhangzhou Affiliated Hospital of Fujian Medical University (PDB202109). Data Sharing Statement The dataset analyzed for this study is available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was approved by the Ethics Committee of Zhangzhou Hospital Affiliated to Fujian Medical University (No. 2024KYB068). Informed consent was obtained from all subjects and/or their legal guardian(s). All procedures were undertaken in accordance with the Helsinki Declaration and all methods were carried out in accordance with relevant guidelines and regulations in the declaration. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209–49. Mokadem I, Dijksterhuis W, van Putten M, et al. Recurrence after Preoperative Chemotherapy and Surgery for Gastric Adenocarcinoma: A Multicenter Study. Gastric Cancer. 2019;22:1263–73. Morgagni P, Bencivenga M, Carneiro F et al. International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape: Bertinoro Workshop, November 2022. Gastric Cancer. 2024 Apr 18. Bhandare MS, Gundavda KK, Yelamanchi R, et al. Impact of pCR after neoadjuvant chemotherapy and radical D2 dissection in locally advanced gastric cancers: Analysis of 1001 cases. Eur J Surg Oncol. 2024;50:108343. Wang X, Lu C, Wei B, et al. Perioperative versus adjuvant S-1 plus oxaliplatin chemotherapy for stage II/III resectable gastric cancer (RESONANCE): a randomized, open-label, phase 3 trial. J Hematol Oncol. 2024;17:17. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20. Koemans WJ, Luijten J, van der Kaaij RT, et al. The metastatic pattern of intestinal and diffuse type gastric carcinoma-A Dutch national cohort study. Cancer Epidemiol. 2020;69:101846. Jiao X, Wang Y, Wang F, et al. Recurrence pattern and its predictors for advanced gastric cancer after total gastrectomy. Med (Baltim). 2020;99:e23795. Yang JY, Park JH, Choi SJ, et al. Role of Recurrence Pattern Multiplicity in Predicting Postrecurrence Survival in Patients Who Underwent Curative Gastrectomy for Gastric Cancer. J Gastric Cancer. 2024;24:231–42. Beeharry MK, Zhu ZL, Liu WT, et al. Prophylactic HIPEC with radical D2 gastrectomy improves survival and peritoneal recurrence rates for locally advanced gastric cancer: personal experience from a randomized case control study. BMC Cancer. 2019;19:932. Lee TY, Hsu CH, Fan HL, et al. Prophylactic hyperthermic intraperitoneal chemotherapy for patients with clinical T4 gastric cancer. Eur J Surg Oncol. 2022;48:1972–9. Xie TY, Wu D, Li S, et al. Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer. World J Gastrointest Oncol. 2020;12:782–90. Liu L, Wang Z, Li B, et al. A novel method of bedside hyperthermic intraperitoneal chemotherapy as adjuvant therapy for stage-III gastric cancer. Int J Hyperth. 2020;37:201–9. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:3277–9. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:1–25. Chen LQ, Zhou ZG, Liu F, et al. Priority of lymph node dissection for advanced esophagogastric junction adenocarcinoma with the tumor center located below the esophagogastric junction. Gastric Cancer. 2011;14:113–23. Ajani JA, D'Amico TA, Bentrem DJ, et al. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20:167–92. Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Natl Cancer Cent. 2022;2:1–9. Huang ZN, Tang YH, Zhong Q et al. Assessment of Laparoscopic Indocyanine Green Tracer-Guided Lymphadenectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Randomized Controlled Trial. Ann Surg. 2024 Feb 20. Li Z, Shan F, Ying X, et al. Assessment of Laparoscopic Distal Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Randomized Clinical Trial. JAMA Surg. 2019;154:1093–101. Chen Z, Chen G, Li Y, et al. Comparison of totally laparoscopic and laparoscopic-assisted approach in gastrectomy with D2 lymphadenectomy for advanced gastric cancer after neoadjuvant chemotherapy: a retrospective comparative study. Ann Surg Treat Res. 2024;106:218–24. Reutovich MY, Krasko OV, Sukonko OG. Hyperthermic intraperitoneal chemotherapy in prevention of gastric cancer metachronous peritoneal metastases: a systematic review. J Gastrointest Oncol. 2021;12(Suppl 1):S5–17. Desiderio J, Chao J, Melstrom L, et al. The 30-year experience-a meta-analysis of randomized and high-quality nonrandomized studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer. Eur J Cancer. 2017;79:1–14. Fan B, Bu Z, Zhang J, et al. Phase II trial of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer after curative surgery. BMC Cancer. 2021;21:216. Chen C, Justo M, Gangi A. Hyperthermic intraperitoneal chemotherapy for gastric cancer: a narrative review. Chin Clin Oncol. 2023;12:68. Badgwell B, Estrella J, Roy-Chowdhuri S, et al. Updated Analysis of a Phase 2 Trial of Cytoreduction, Gastrectomy, and Hyperthermic Intraperitoneal Perfusion with Chemotherapy for Patients with Peritoneal Carcinoma from Gastric Cancer. Ann Surg Oncol. 2024;31:2824–5. Allievi N, Bianco F, Pisano M, et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) as adjuvant and therapeutic options for patients with advanced gastric cancer at high risk of recurrence or established peritoneal metastases: a single-center experience. Updates Surg. 2023;75:159–67. Rau B, Lang H, Koenigsrainer A, et al. Effect of Hyperthermic Intraperitoneal Chemotherapy on Cytoreductive Surgery in Gastric Cancer With Synchronous Peritoneal Metastases: The Phase III GASTRIPEC-I Trial. J Clin Oncol. 2024;42:146–56. Diniz TP, da Costa WL Jr, de Jesus F. Does hipec improve outcomes in gastric cancer patients treated with perioperative chemotherapy and radical surgery? A propensity-score matched analysis. J Surg Oncol. 2020;121:823–32. Guo J, Deng Z, Jin L, et al. Prognostic value of hyperthermic intraperitoneal chemotherapy in gastric cancer with synchronous peritoneal metastases: a real-world retrospective study. J Cancer Res Clin Oncol. 2023;149:17881–96. Tables Table1. Characteristics of Patients in the HIPEC and Non HIPEC Groups before and after matching Overall cohort After propensitymatching Characteristics Non-HIPEC HIPEC P value Non-HIPEC HIPEC P value (n=142) (n=32) (n=51) (n=29) Age, yrs 62.0±10.1 62.9±10.4 0.284 61.3±10.53 63.0±9.3 0.154 Sex 0.683 0.746 Male 107（75.4%） 23(71.9%) 37(72.5%) 22(75.9%) Female 35（25.6%） 9(28.1%) 14(27.5%) 7(24.1%) BMI, kg/m2 22.1±3.2 22.3±2.9 0.331 21.9±3.1 22.2±2.9 0.394 ASA status 0.696 0.847 1 70（49.3%） 17(53.1%) 27(52.9%) 16(55.2%) 2 72（50.7%） 15(46.9%) 24(47.1%) 13(44.8%) Vascular invasion <0.001 0.286 No 70（49.3%） 5(15.6%) 11(21.6%) 4(13.8%) Yes 72（50.7%） 27(84.3%) 40(78.4%) 25(86.2%) Perineural invasion 0.003 0.370 No 51（35.9%） 1(3.1%) 6(11.8%) 1(3.4%) Yes 91(64.1%) 31(96.9%) 45(88.2%) 28(96.6%) Tumor size 52.4±22.9 49.2±21.5 0.076 54.9±23.9 54.4±22.1 0.860 Extended resection 0.643 0.226 No 120（84.5%） 27(84.3%) 41(80.4%) 25(86.2%) Yes 22（15.5%） 5(15.6%) 10(19.6%) 4(13.8%) Histopathological grade 0.013 0.070 G1 4（2.8%） 0(0.0%) 1(2.0%) 0(0.0.%) G2 47（33.1%） 3(9.4%) 16(31.4%) 3(10.3%) G3 91(64.1%) 29(90.6%) 34(66.6%) 26(89.7%) Lauren subtype 0.003 0.255 intestinal type 82(57.7%) 10(31.3%) 27(52.9%) 13(44.8%) diffuse type 35(24.6%) 14(43.7%) 15(29.4%) 10(34.5%) hybrid type 25(17.7%) 8(25.0%) 9(17.7%) 6(20.7%) Tumor location 0.421 0.554 U 79(55.6%) 21(65.6%) 26(51.0%) 18(62.1%) M 53(37.3%) 6(18.8%) 16(31.4%) 6(20.7%) L 20(14.1%) 5(15.6%) 9(17.6%) 5(17.2%) cT category 0.839 0448 4a 86(60.6%) 20(62.5%) 29(56.9%) 19(65.5%) 4b 56(34.4%) 12(37.5%) 22(43.1%) 10(34.5%) pT category <0.001 0.915 T0 7(4.9%) 0(0.0.%) 0(0.0.%) 0(0.0.%) T1 12(8.5%) 0(0.0.%) 0(0.0.%) 0(0.0.%) T2 18(12.7%) 0(0.0.%) 0(0.0.%) 0(0.0.%) T3 35(24.6%) 1(3.1%) 2(3.9%) 1(3.4%) T4 70(49.3%) 31(96.9%) 49(96.1%) 28(96.6%) pN category 0.003 0.689 N0 51(35.9%) 4(12.5%) 5(9.8%) 4(13.8%) N1 35(24.6%) 8(25.0%) 15(29.4%) 8(27.6%) N2 24(16.9%) 3(9.4%) 10(19.6%) 3(10.3%) N3 32(22.5%) 17(53.1%) 21(41.2%) 14(28.3%) pTNM stage 0.002 0.767 0 7(4.9%) 0(0.0.%) 0(0.0.%) 0(0.0.%) I 21(14.8%) 1(3.1%) 1(2.0%) 1(3.4%) II 42(29.6%) 3(9.4%) 7(13.7%) 3(10.3%) III 72(50.7%) 28(87.5%) 43(84.3%) 25(86.3%) Abbreviations : HIPEC, hyperthermic intraperitoneal chemotherapy; BMI, body mass index; ASA, American society of anesthesiologists physical status classification. Table2. Comparison of postoperative recurrence and metastasis in the two groups Overall cohort After propensitymatching Sites Non-HIPEC HIPEC P value Non-HIPEC HIPEC P value (n=142) (n=32) (n=51) (n=29) Local regions 0.892 0.915 No 134（94.4%） 30（93.8%） 49（96.1%） 28（96.6%） Yes 8（5.6%） 2（6.2%） 2（3.9%） 1（3.4%） Peritoneum 0.540 0.041 No 118（83.1%） 28（87.5%） 38（74.5%） 27（93.1%） Yes 24（16.9%） 4（12.5%） 13（25.5%） 2（6.9%） Liver 0.775 0.631 No 136（95.8%） 31（96.9%） 48（94.1%） 28（96.6%） Yes 6（4.2%） 1（3.1%） 3（5.9%） 1（3.4%） Lung 0.237 0.122 No 136（95.8%） 32（100.0%） 47（92.2%） 29（100.0%） Yes 6（4.2%） 0（0.0%） 4（7.8%） 0（0.0%） Other distal organs 0.912 0.682 No 137（96.5%） 31（96.9%） 50（98.0%） 28（96.6%） Yes 5（3.5%） 1（3.1%） 1（2.0%） 1（3.4%） Bone 0.925 0.915 No 138（97.2%） 31（96.9%） 49（96.1%） 28（96.6%） Yes 4（2.8%） 1（3.1%） 2（3.9%） 1（3.4%） Lymph node 0.679 0.640 No 130（91.5%） 30（93.8%） 46（90.2%） 27（93.1%） Yes 12（8.5%） 2（6.2%） 5（9.8%） 2（6.9%） Total 0.240 0.07 No 77（54.2%） 21（65.6%） 21（41.2%） 21（72.4%） Yes 65（45.8%） 11（34.4%） 30（58.2%） 8（27.6%） Abbreviations : HIPEC, hyperthermic intraperitoneal chemotherapy. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Sep, 2024 Read the published version in World Journal of Surgical Oncology → Version 1 posted Editorial decision: Revision requested 26 Jul, 2024 Reviews received at journal 25 Jul, 2024 Reviews received at journal 24 Jul, 2024 Reviews received at journal 21 Jul, 2024 Reviewers agreed at journal 20 Jul, 2024 Reviewers agreed at journal 19 Jul, 2024 Reviewers agreed at journal 16 Jul, 2024 Reviewers agreed at journal 15 Jul, 2024 Reviews received at journal 09 Jul, 2024 Reviewers agreed at journal 08 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 03 Jul, 2024 Reviewers agreed at journal 08 Jun, 2024 Reviewers invited by journal 05 Jun, 2024 Editor assigned by journal 31 May, 2024 Submission checks completed at journal 27 May, 2024 First submitted to journal 22 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4461027","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":312014448,"identity":"6a36d928-8759-419a-afa9-e1e5bd9103fb","order_by":0,"name":"Chenbin Lv","email":"","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University's Gastric Surgery Department","correspondingAuthor":false,"prefix":"","firstName":"Chenbin","middleName":"","lastName":"Lv","suffix":""},{"id":312014449,"identity":"4daf7f5d-e43b-4806-b931-98bec2d4b68f","order_by":1,"name":"Lin-Yan Tong","email":"","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lin-Yan","middleName":"","lastName":"Tong","suffix":""},{"id":312014451,"identity":"69d7c97a-cf8b-4f5c-86bb-b0f2356032b4","order_by":2,"name":"Wei-Ming Zeng","email":"","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University's Gastric Surgery Department","correspondingAuthor":false,"prefix":"","firstName":"Wei-Ming","middleName":"","lastName":"Zeng","suffix":""},{"id":312014456,"identity":"ae8a1b3b-ce9a-47b1-b63b-6c4e53e90d92","order_by":3,"name":"Qiu-Xian Chen","email":"","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University's Gastric Surgery Department","correspondingAuthor":false,"prefix":"","firstName":"Qiu-Xian","middleName":"","lastName":"Chen","suffix":""},{"id":312014458,"identity":"28ffe4b0-390f-467f-a845-a1d04b8cba5a","order_by":4,"name":"Shun-Yong Fang","email":"","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shun-Yong","middleName":"","lastName":"Fang","suffix":""},{"id":312014460,"identity":"a261a07c-257b-494b-ab93-b28e26c8b672","order_by":5,"name":"Yu-Qin Sun","email":"","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University's Gastric Surgery Department","correspondingAuthor":false,"prefix":"","firstName":"Yu-Qin","middleName":"","lastName":"Sun","suffix":""},{"id":312014462,"identity":"c0755b21-faca-4c1f-a888-6a2d7cf24acc","order_by":6,"name":"Li-Sheng Cai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYFACxsYDCQwHwKwDDBUScvJEaGmAaQGSZyyMDRuIsOcAA0wLY1tFIpSNG/C3H2448ODPHTlz/sUPDv6cJ5HA2MD88NENPFokziQ2HEhse2ZsOeOZwWHebRJ57AxsxsY5eLQYMIC0NBxO3HDjDMNhxm0SxYwNPGzSeLXwPwR6/8/hepCWgz/nSABNIKQFpCaB7XCCwfkehgO8DURokbjxEOSXw4YbbrAZHOY5JmFs2EzAL/z96Q8f/vhzWN7g/GEgo6ZOTp69+eFjfFqQ7EuAMpiJUg627wDRSkfBKBgFo2CEAQDOUVshlivALgAAAABJRU5ErkJggg==","orcid":"","institution":"Zhangzhou Affiliated Hospital of Fujian Medical University's Gastric Surgery Department","correspondingAuthor":true,"prefix":"","firstName":"Li-Sheng","middleName":"","lastName":"Cai","suffix":""}],"badges":[],"createdAt":"2024-05-22 12:51:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4461027/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4461027/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12957-024-03526-y","type":"published","date":"2024-09-11T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58170303,"identity":"39b16ca2-4a36-4b3e-b314-736c594ede25","added_by":"auto","created_at":"2024-06-12 03:38:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":130126,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flowchart\u003c/p\u003e\n\u003cp\u003eHIPEC: hyperthermic intraperitoneal chemotherapy\u003c/p\u003e","description":"","filename":"Fig.11.png","url":"https://assets-eu.researchsquare.com/files/rs-4461027/v1/21c7a1ee098c9731de97d17a.png"},{"id":58170309,"identity":"7fcc9737-3b59-4c10-95c0-d94028c40bef","added_by":"auto","created_at":"2024-06-12 03:38:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":126951,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the overall and disease-free survival rates of patients in the HIPEC and non-HIPEC groups before matching: (A) 3-year overall survival outcomes and (B) 3-year disease-free survival outcomes.\u003c/p\u003e\n\u003cp\u003eHIPEC: hyperthermic intraperitoneal chemotherapy; HIPEC(0): non-HIPEC group; HIPEC(1): HIPEC group\u003c/p\u003e","description":"","filename":"Fig213.png","url":"https://assets-eu.researchsquare.com/files/rs-4461027/v1/0c63c4a031e295ee8e31c83a.png"},{"id":58170304,"identity":"e64baec6-8327-4a44-aadb-588e15deda1b","added_by":"auto","created_at":"2024-06-12 03:38:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":211793,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the overall and disease-free survival rates of patients in the HIPEC and non-HIPEC groups after matching: (A) 3-year overall survival outcomes of all patients, (B) 3-year disease-free survival outcomes of all patients, (C) 3-year overall survival outcomes of stage III patients and (D) 3-year disease-free survival outcomes of stage III patients.\u003c/p\u003e\n\u003cp\u003eHIPEC: hyperthermic intraperitoneal chemotherapy; HIPEC(0): non-HIPEC group; HIPEC(1): HIPEC group\u003c/p\u003e","description":"","filename":"Fig311.png","url":"https://assets-eu.researchsquare.com/files/rs-4461027/v1/ce2ab5c82c7c73433fe9d779.png"},{"id":64619038,"identity":"71de506d-5c54-4069-973f-80f44b58c016","added_by":"auto","created_at":"2024-09-16 16:10:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1433957,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4461027/v1/23910ffc-1006-442f-87dc-103fac0faca8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGastric cancer is a prevalent type of cancer globally, with high rates of occurrence and death, ranking fifth and fourth in terms of malignant tumors, respectively [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite radical surgery being the primary and most efficient treatment for gastric cancer, approximately 70% of patients still experience recurrence and metastasis after surgery, particularly those with cT4 gastric cancer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Multiple research studies indicate that neoadjuvant chemotherapy has the potential to lower the likelihood of postoperative recurrence and metastasis and enhance the outlook for individuals diagnosed with advanced gastric cancer [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nevertheless, the prognosis for patients with advanced gastric cancer remains poor, with the recurrence rate of peritoneal implantation metastasis after radical gastrectomy ranging from 35\u0026ndash;50%, making it the primary mode of recurrence for gastric cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Hence, preventing peritoneal metastasis following radical gastrectomy is crucial.\u003c/p\u003e \u003cp\u003eHIPEC can successfully prevent peritoneal metastasis in gastric cancer patients by administering chemotherapy drugs directly into the abdomen and utilizing high temperatures to eliminate cancer cells. Several research studies indicate that HIPEC can be beneficial for reducing peritoneal metastasis and increasing the survival rate of individuals diagnosed with late-stage gastric cancer [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For cT4 gastric cancer patients, who have a high risk of postoperative recurrence and peritoneal metastasis, laparoscopic surgery after neoadjuvant chemotherapy allows patients to benefit from minimally invasive surgery while receiving standardized gastric cancer treatment. Combined with postoperative prophylactic HIPEC, this approach is expected to improve patient prognosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e In this research, we utilized propensity score matching to assess the effectiveness of neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy along with postoperative HIPEC for preventing cancer in individuals with cT4N\u0026thinsp;+\u0026thinsp;M0 gastric cancer by contrasting the recurrence rates, 3-year overall survival (OS), and disease-free survival (DFS) among the non-HIPEC and prophylactic HIPEC groups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis study analyzed the medical records of 223 patients diagnosed with cT4N\u0026thinsp;+\u0026thinsp;M0 gastric cancer who underwent laparoscopic total gastrectomy following neoadjuvant chemotherapy at Zhangzhou Hospital, Fujian Medical University's Department of Gastric Surgery, from June 2017 to December 2021.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were patients with advanced tumors who were staged as T4a-b, N+, or M0 on preoperative imaging; aged 18\u0026ndash;75 years; pathologically diagnosed with gastric adenocarcinoma; provided informed consent; and underwent laparoscopic radical total gastrectomy and standardized D2 lymph node dissection. Exclusion criteria included preoperative or intraoperative identification of peritoneal and distant spread of cancer, incomplete resection, contraindications to HIPEC or systemic chemotherapy drugs, previous malignancies within the past 5 years, and the need for simultaneous surgery for other conditions. The 174 eligible patients were categorized into two groups based on whether postoperative HIPEC was conducted: a non-HIPEC group consisting of 142 patients and a HIPEC group consisting of 32 patients. To make the data of the two groups comparable, age, sex, and tumor stage were utilized as matching criteria, and the propensity score technique was employed to pair the two groups at a ratio of 1:2, with a caliper threshold of 0.2. A total of 80 patients were divided into two groups: 29 in the HIPEC group and 51 in the non-HIPEC group, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e This retrospective study was approved by the Ethics Committee of Zhangzhou Hospital Affiliated with Fujian Medical University. All patients underwent standard preoperative tests, such as CT scans of the chest and abdomen and tumor marker analysis; additional imaging, such as positron emission tomography (PET)-CT and bone scans, was performed as needed to check for distant spread of the cancer. The stage of gastric cancer was classified according to the 8th edition of the American Joint Committee on Cancer (AJCC) on Cancer Staging System [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSurgical methods and HIPEC procedure\u003c/h2\u003e \u003cp\u003eAn identical team of surgeons conducted every surgery, with each patient receiving laparoscopic radical total gastrectomy with D2 lymphadenectomy following the 2010 3rd edition of the Japanese Guidelines for Gastric Cancer Treatment [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The patient was positioned lying on their back with their legs apart, and a small tube was inserted below the belly button for observation; a larger tube was inserted 2 cm below the rib on the left side for the main procedure; and smaller tubes were inserted on the right side below the rib and above the belly button on both sides for additional procedures, with a pressure of 12 mmHg in the abdomen. The surgeon stood to the left of the patient, the assistant to the right, and a mirror holder was positioned between the patient's legs. D2 lymph node dissection was carried out, with the specific steps of the dissection being documented in a previous publication [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Total gastrectomy was performed with esophagus-jejunum Roux-en-Y digestive tract reconstruction.\u003c/p\u003e \u003cp\u003eIn the HIPEC group, approximately 3 weeks postsurgery, a 16-gauge needle guided by a color ultrasound was used to perform left upper and right lower abdominal punctures and catheterizations in the treatment room next to the bed. Hyperthermic perfusion and circulation were performed using a HIPEC machine (China, Model: HGGZ-102). The perfusion solution was consistently introduced and removed from the abdominal cavity at a steady temperature, rate, and quantity. The prophylactic HIPEC regimen consisted of 80 mg of docetaxel (60 min, 42\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u0026deg;C). The perfusion fluid was a mixture of normal saline and docetaxel at a dose of 3000\u0026ndash;5000 ml. The circulation flow rate was 300\u0026ndash;500 ml/min, and a total of 1\u0026ndash;3 courses were administered according to the patient's tolerance, with an interval of 48 h between treatments. During the perfusion process, the patient was instructed to turn over appropriately from side to side to allow the drug to fully contact the peritoneum and enhance its therapeutic effect.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePerioperative chemotherapy scheme and cycle\u003c/h2\u003e \u003cp\u003eAll individuals were treated with neoadjuvant chemotherapy followed by postoperative adjuvant chemotherapy using the SOX (Oxaliplatin and S-1) or XELOX (Oxaliplatin and Capecitabine) regimen [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The patients received 2\u0026ndash;4 cycles of chemotherapy before surgery and 4\u0026ndash;6 cycles of chemotherapy after surgery. The HIPEC team began administering standard chemotherapy 48 hours post-HIPEC, while the control group initiated their first chemotherapy treatment 3 to 4 weeks postsurgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative follow-up\u003c/h2\u003e \u003cp\u003ePostoperative follow-ups were conducted by a dedicated person through outpatient visits, home visits and telephone calls. Follow-up assessments were performed every quarter for the first 2 years and then biannually for the following 3\u0026ndash;5 years. The majority of patients received standard physical check-ups, blood tests (such as CA19-9 and CEA levels), chest X-rays, full abdominal ultrasounds or CT scans, and yearly gastroscopies. The OS time was recorded from the time of surgery to the last follow-up, death, or the time when the follow-up database was closed (such as loss to follow-up or death from other diseases). Disease-free survival (DFS) was determined from the date of the surgical procedure until the occurrence of tumor recurrence or mortality. Local recurrence or distant metastasis confirmed by imaging or pathology was considered tumor recurrence, and the site of recurrence was determined based on the earliest location of the finding.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using the R4.1.0 software packages \u0026ldquo;MatchIt\u0026rdquo; and \u0026ldquo;foreign\u0026rdquo; and SPSS 26.0 statistical software. The χ2 test was used for analyzing the categorical data; the measurement data are expressed as χ\u0026thinsp;\u0026plusmn;\u0026thinsp;S. Categorical data were examined with either the χ2 test or Fisher's exact test, whereas numerical data were assessed using the t test. Data that did not follow a normal distribution were examined with the Mann‒Whitney test. Survival rates were calculated with the Kaplan\u0026ndash;Meier method, and the log-rank test was used to compare differences between the two groups. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eComparison of clinicopathologic characteristics between the two groups before and after matching\u003c/h2\u003e \u003cp\u003eThe general clinicopathological characteristics of the entire group of patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Prior to matching, the percentage of individuals with neurovascular invasion, tumor differentiation G2-3, diffuse type Lauren staging, pT staging 3\u0026ndash;4, pN staging 2\u0026ndash;3, and postoperative pathology of Stage II\u0026ndash;III in the HIPEC cohort was notably greater than that in the non-HIPEC cohort. Following the matching process, there were no notable variations in the clinicopathological information of the patients within the two groups, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison of postoperative recurrence between the two groups\u003c/h2\u003e \u003cp\u003eThe peritoneum was the most frequent location for recurrent metastasis in all patients, with distant organs, distant lymph nodes, localized regions, and bone metastases following a decreasing order of prevalence. In the prematched HIPEC group, the total percentage of patients who experienced recurrence was 34.4%, which was less than the percentage in the non-HIPEC group (45.8%), although the difference was not statistically significant. Patients in both groups had similar rates of local recurrence, peritoneal recurrence, and distant metastasis at all locations. The HIPEC group had notably lower recurrence rates at all sites (27.6% vs. 58.2%, P\u0026thinsp;=\u0026thinsp;0.07) and in the lung (0.0% vs. 7.8%, P\u0026thinsp;=\u0026thinsp;0.112) and peritoneum (6.9% vs. 25.5%, P\u0026thinsp;=\u0026thinsp;0.041) than did the non-HIPEC group, as shown in Table\u0026nbsp;2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of survival between the two groups\u003c/h2\u003e \u003cp\u003eThe duration of the follow-up was prolonged until December 2023, with a median follow-up period of 49 months (ranging from 15 to 78 months) for the entire cohort. Prior to comparison, the 3-year overall survival and disease-free survival rates of the HIPEC cohort were similar to those of the non-HIPEC cohort (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA and B). According to the comparison, the 3-year overall survival rate for the HIPEC cohort was 63.2%, which was a notable increase compared to that of the non-HIPEC group (38.5%), despite the lack of statistical significance (P\u0026thinsp;=\u0026thinsp;0.073; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). The three-year disease-free survival rate in the HIPEC cohort was significantly greater than that in the non-HIPEC cohort (59.0% vs. 35.2%, P\u0026thinsp;=\u0026thinsp;0.033), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComparison of survival between the two groups of stage III patients\u003c/h2\u003e \u003cp\u003eAfter stratification by postoperative pathological stage and matching, compared with the non-HIPEC cohort, the HIPEC cohort exhibited superior 3-year OS (62.4% vs. 34.8%, P\u0026thinsp;=\u0026thinsp;0.077) and DFS (47.4% vs. 20.4%, P\u0026thinsp;=\u0026thinsp;0.022) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC and D).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe general enhancement in the outlook for gastric cancer is not substantial. One of the main reasons for this is the high proportion of patients with advanced disease at the time of diagnosis. In China, the number of early gastric cancer cases is 20%, and locally advanced gastric cancer cases account for 70% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Neoadjuvant chemotherapy has become increasingly common for treating locally advanced gastric cancer in recent years due to its ability to decrease tumor size and stage and enhance the rate of surgical resection, particularly for cT4 patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, advancements in laparoscopic tools and the enhanced skills of surgeons have led to increased interest in the use of neoadjuvant chemotherapy alongside radical gastrectomy for treating locally advanced gastric cancer [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Recent research indicates that laparoscopic D2 radical gastrectomy offers specific benefits in managing advanced gastric cancer [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Even with neoadjuvant chemotherapy, laparoscopic surgery is still considered safe and dependable compared to open surgery, with no significant impact on the occurrence or death rate of perioperative complications [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Despite the need for radical surgery, peritoneal metastasis remains the most common and earliest form of disease progression in patients with gastric cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Approximately 50% of patients develop peritoneal metastasis after surgery, with an extremely poor prognosis[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The best combination of multimodal treatments, such as HIPEC in adjuvant therapy, is being explored to prevent peritoneal metastasis in gastric cancer patients.\u003c/p\u003e \u003cp\u003eThe application of therapeutic HIPEC has been recognized in patients who have developed peritoneal metastasis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Nevertheless, the effectiveness of preventive HIPEC in decreasing the incidence of peritoneal metastasis in gastric cancer patients with high-risk factors such as stage T4 disease is still under investigation. A meta-analysis involving 32 nonrandomized controlled trials (2520 patients) revealed that radical surgery with HIPEC was effective at reducing the risk of peritoneal metastasis (RR\u0026thinsp;=\u0026thinsp;0.63, 95% CI 0.45\u0026ndash;0.88; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. An analysis of the clinical and pathological information of 132 patients with cT4 gastric cancer performed by Lee et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] revealed that undergoing radical gastrectomy along with early postoperative prophylactic HIPEC could lower the occurrence of peritoneal metastasis, although it did not affect the rate of distant metastasis. A phase II clinical study conducted by Fan et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] revealed that radical gastrectomy combined with cisplatin HIPEC did not reduce the recurrence rate of peritoneal metastasis. However, in most studies, HIPEC was performed under general anesthesia with thicker catheters placed during the operation, especially during or immediately after the operation, and only one treatment was performed, which may pose some risks [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Modified HIPEC treatment under bedside ultrasound guidance requires only local anesthesia and the use of thinner catheters, which is well tolerated, safe, and repetitive in patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a study involving patients with stage III gastric cancer, researchers utilized bedside-adapted HIPEC and discovered that administering prophylactic HIPEC after surgery decreased the chances of ovarian (7.0% vs. 0.0%) and peritoneal metastasis (21.1% vs. 10.5%, P\u0026thinsp;=\u0026thinsp;0.198). However, there was no significant difference in metastasis to other locations (such as the lung, bone, brain, liver, or abdominal lymph nodes) between the two groups. The research indicated that administering prophylactic HIPEC at the bedside after surgery notably decreased the occurrence of peritoneal recurrence in individuals with cT4 stomach cancer (6.9% vs. 25.5%, P\u0026thinsp;=\u0026thinsp;0.041).\u003c/p\u003e \u003cp\u003eNevertheless, the outcome for individuals with cT4 stomach cancer following prophylactic HIPEC surgery is still uncertain. Previous studies revealed that administering postoperative prophylactic HIPEC enhanced long-term survival outcomes for patients diagnosed with late-stage gastric cancer [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to a study by Allievi et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], HIPEC increased the 1- and 3-year OS and DFS rates for patients with advanced gastric cancer at high risk of recurrence. A multicenter prospective clinical study indicated no difference in OS between the HIPEC and non-HIPEC groups, while DFS was significantly better in the HIPEC group [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. On the other hand, Diniz and colleagues [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported that HIPEC treatment did not improve patient prognosis. A real-world retrospective study from China also showed no survival benefit for gastric cancer patients who underwent HIPEC (P\u0026thinsp;=\u0026thinsp;0.220 for OS and P\u0026thinsp;=\u0026thinsp;0.370 for cancer-specific survival) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In this study, the 3-year OS and DFS rates in the HIPEC group were greater than those in the non-HIPEC group. HIPEC significantly enhanced the 3-year overall survival (62.4% vs. 34.8%, P\u0026thinsp;=\u0026thinsp;0.077) and disease-free survival (47.4% vs. 20.4%, P\u0026thinsp;=\u0026thinsp;0.022) rates, especially in patients with stage III cancer following neoadjuvant chemotherapy. Liu et al.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] also showed that the middle DFS (29 compared to 15 months, P\u0026thinsp;=\u0026thinsp;0.006) and OS (42 compared to 31 months, P\u0026thinsp;=\u0026thinsp;0.042) in the HIPEC category were notably greater than those in the non-HIPEC category. Hence, effective treatments for advanced-stage T4 gastric cancer require a combination of therapies and ongoing optimization.\u003c/p\u003e \u003cp\u003eThere were certain limitations in this research. This was a single-center retrospective study, which may have led to bias. Hence, we employed propensity score matching to reduce selection bias, enhancing comparability between the two groups and increasing the accuracy of the results. Second, the sample size was small, and the long-term oncologic outcomes of neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy and postoperative preventive HIPEC need to be confirmed in large-sample, multicenter, randomized controlled studies.\u003c/p\u003e \u003cp\u003eIn conclusion, our study suggested that postoperative prophylactic HIPEC can reduce the rate of peritoneal metastasis in patients with cT4N\u0026thinsp;+\u0026thinsp;M0 advanced gastric cancer and improve the prognosis of such patients.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003ecT stage Clinical T stage\u003c/p\u003e \u003cp\u003eHIPEC Hyperthermic intraperitoneal chemotherapy\u003c/p\u003e \u003cp\u003epT stage Pathological T stage\u003c/p\u003e \u003cp\u003epN stage Pathological N stage\u003c/p\u003e \u003cp\u003eCT Computed tomography\u003c/p\u003e \u003cp\u003ePET Positron emission tomography\u003c/p\u003e \u003cp\u003e AJCC American Joint Committee on Cancer\u003c/p\u003e \u003cp\u003eDFS Disease-free survival\u003c/p\u003e \u003cp\u003eOS Overall survival\u003c/p\u003e \u003cp\u003eBMI Body mass index\u003c/p\u003e \u003cp\u003eASA American society of anesthesiologists physical status classification\u003c/p\u003e \u003cp\u003eSOX Oxaliplatin and S-1\u003c/p\u003e \u003cp\u003eXELOX Oxaliplatin and Capecitabine\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express gratitude to the individuals who contributed significantly to this research, such as nurses, pathologists, postgraduate physicians, data analysts, peer reviewers, and editorial staff. They did not receive any financial compensation for the work they did.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChen-Bin Lv, Lin-yan Tong, and Wei-Ming Zeng conceived the study, analyzed the data, and drafted the manuscript. Li-Sheng Cai helped critically revise the manuscript for important intellectual content. Qiu-Xian Chen, Shun-Yong Fang, and Yu-Qin Sun helped collect the data and design the study. All the authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding for this research was provided by the Startup Fund for Scientific Research at Fujian Medical University (2018QH1214) and the Climbing Fund for PhD Workstation at Zhangzhou Affiliated Hospital of Fujian Medical University (PDB202109).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sharing Statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe dataset analyzed for this study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Zhangzhou Hospital Affiliated to Fujian Medical University (No. 2024KYB068). Informed consent was obtained from all subjects and/or their legal guardian(s). All procedures were undertaken in accordance with the Helsinki Declaration and all methods were carried out in accordance with relevant guidelines and regulations in the declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMokadem I, Dijksterhuis W, van Putten M, et al. Recurrence after Preoperative Chemotherapy and Surgery for Gastric Adenocarcinoma: A Multicenter Study. Gastric Cancer. 2019;22:1263\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgagni P, Bencivenga M, Carneiro F et al. International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape: Bertinoro Workshop, November 2022. Gastric Cancer. 2024 Apr 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhandare MS, Gundavda KK, Yelamanchi R, et al. Impact of pCR after neoadjuvant chemotherapy and radical D2 dissection in locally advanced gastric cancers: Analysis of 1001 cases. Eur J Surg Oncol. 2024;50:108343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Lu C, Wei B, et al. Perioperative versus adjuvant S-1 plus oxaliplatin chemotherapy for stage II/III resectable gastric cancer (RESONANCE): a randomized, open-label, phase 3 trial. J Hematol Oncol. 2024;17:17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoemans WJ, Luijten J, van der Kaaij RT, et al. The metastatic pattern of intestinal and diffuse type gastric carcinoma-A Dutch national cohort study. Cancer Epidemiol. 2020;69:101846.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiao X, Wang Y, Wang F, et al. Recurrence pattern and its predictors for advanced gastric cancer after total gastrectomy. Med (Baltim). 2020;99:e23795.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang JY, Park JH, Choi SJ, et al. Role of Recurrence Pattern Multiplicity in Predicting Postrecurrence Survival in Patients Who Underwent Curative Gastrectomy for Gastric Cancer. J Gastric Cancer. 2024;24:231\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeeharry MK, Zhu ZL, Liu WT, et al. Prophylactic HIPEC with radical D2 gastrectomy improves survival and peritoneal recurrence rates for locally advanced gastric cancer: personal experience from a randomized case control study. BMC Cancer. 2019;19:932.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee TY, Hsu CH, Fan HL, et al. Prophylactic hyperthermic intraperitoneal chemotherapy for patients with clinical T4 gastric cancer. Eur J Surg Oncol. 2022;48:1972\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie TY, Wu D, Li S, et al. Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer. World J Gastrointest Oncol. 2020;12:782\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu L, Wang Z, Li B, et al. A novel method of bedside hyperthermic intraperitoneal chemotherapy as adjuvant therapy for stage-III gastric cancer. Int J Hyperth. 2020;37:201\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:3277\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJapanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:1\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen LQ, Zhou ZG, Liu F, et al. Priority of lymph node dissection for advanced esophagogastric junction adenocarcinoma with the tumor center located below the esophagogastric junction. Gastric Cancer. 2011;14:113\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAjani JA, D'Amico TA, Bentrem DJ, et al. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20:167\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Natl Cancer Cent. 2022;2:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang ZN, Tang YH, Zhong Q et al. Assessment of Laparoscopic Indocyanine Green Tracer-Guided Lymphadenectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Randomized Controlled Trial. Ann Surg. 2024 Feb 20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Z, Shan F, Ying X, et al. Assessment of Laparoscopic Distal Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Randomized Clinical Trial. JAMA Surg. 2019;154:1093\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Z, Chen G, Li Y, et al. Comparison of totally laparoscopic and laparoscopic-assisted approach in gastrectomy with D2 lymphadenectomy for advanced gastric cancer after neoadjuvant chemotherapy: a retrospective comparative study. Ann Surg Treat Res. 2024;106:218\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReutovich MY, Krasko OV, Sukonko OG. Hyperthermic intraperitoneal chemotherapy in prevention of gastric cancer metachronous peritoneal metastases: a systematic review. J Gastrointest Oncol. 2021;12(Suppl 1):S5\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesiderio J, Chao J, Melstrom L, et al. The 30-year experience-a meta-analysis of randomized and high-quality nonrandomized studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer. Eur J Cancer. 2017;79:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan B, Bu Z, Zhang J, et al. Phase II trial of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer after curative surgery. BMC Cancer. 2021;21:216.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, Justo M, Gangi A. Hyperthermic intraperitoneal chemotherapy for gastric cancer: a narrative review. Chin Clin Oncol. 2023;12:68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadgwell B, Estrella J, Roy-Chowdhuri S, et al. Updated Analysis of a Phase 2 Trial of Cytoreduction, Gastrectomy, and Hyperthermic Intraperitoneal Perfusion with Chemotherapy for Patients with Peritoneal Carcinoma from Gastric Cancer. Ann Surg Oncol. 2024;31:2824\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllievi N, Bianco F, Pisano M, et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) as adjuvant and therapeutic options for patients with advanced gastric cancer at high risk of recurrence or established peritoneal metastases: a single-center experience. Updates Surg. 2023;75:159\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRau B, Lang H, Koenigsrainer A, et al. Effect of Hyperthermic Intraperitoneal Chemotherapy on Cytoreductive Surgery in Gastric Cancer With Synchronous Peritoneal Metastases: The Phase III GASTRIPEC-I Trial. J Clin Oncol. 2024;42:146\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiniz TP, da Costa WL Jr, de Jesus F. Does hipec improve outcomes in gastric cancer patients treated with perioperative chemotherapy and radical surgery? A propensity-score matched analysis. J Surg Oncol. 2020;121:823\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo J, Deng Z, Jin L, et al. Prognostic value of hyperthermic intraperitoneal chemotherapy in gastric cancer with synchronous peritoneal metastases: a real-world retrospective study. J Cancer Res Clin Oncol. 2023;149:17881\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable1. Characteristics of Patients in the HIPEC and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNon\u003c/strong\u003e\u003cstrong\u003eHIPEC Groups before and after matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.1311706629055%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.2228490832158%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.244005641748942%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.40197461212976%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter propensitymatching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.163841807909606%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.536723163841808%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-HIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.288135593220339%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.310734463276836%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.248587570621469%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.536723163841808%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-HIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.169491525423728%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.745762711864407%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.163841807909606%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.536723163841808%\" valign=\"bottom\"\u003e\n \u003cp\u003e(n=142)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.288135593220339%\" valign=\"bottom\"\u003e\n \u003cp\u003e(n=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.310734463276836%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.248587570621469%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.536723163841808%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e(n=51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.169491525423728%\" valign=\"bottom\"\u003e\n \u003cp\u003e(n=29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.745762711864407%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, yrs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e62.0\u0026plusmn;10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e62.9\u0026plusmn;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e61.3\u0026plusmn;10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e63.0\u0026plusmn;9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e107（75.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e23(71.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e37(72.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e22(75.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e35（25.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e9(28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e14(27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e7(24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.1\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.3\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e21.9\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e22.2\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e70（49.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e17(53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e27(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e16(55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e72（50.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e15(46.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e24(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e13(44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e70（49.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e5(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e11(21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e4(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e72（50.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e27(84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e40(78.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e25(86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerineural invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e51（35.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e6(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e91(64.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e31(96.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e45(88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e28(96.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e52.4\u0026plusmn;22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e49.2\u0026plusmn;21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e54.9\u0026plusmn;23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e54.4\u0026plusmn;22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"top\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtended resection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e120（84.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e27(84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e41(80.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e25(86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e22（15.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e5(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e10(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e4(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistopathological grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"top\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e4（2.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e47（33.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e3(9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e16(31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e3(10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e91(64.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e29(90.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e34(66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e26(89.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLauren \u0026nbsp;subtype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"top\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eintestinal type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e82(57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e10(31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e27(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e13(44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003ediffuse type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e35(24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e14(43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e15(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e10(34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003ehybrid type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e25(17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e8(25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e9(17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e6(20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor \u0026nbsp;location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e79(55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e21(65.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e26(51.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e18(62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e53(37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e6(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e16(31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e6(20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e20(14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e5(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e9(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e5(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ecT category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e4a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e86(60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e20(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e29(56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e19(65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e4b\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e56(34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e12(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e22(43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e10(34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003epT category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e7(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e12(8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e18(12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e35(24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e70(49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e31(96.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e49(96.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e28(96.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003epN category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e51(35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e4(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e5(9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e4(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e35(24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e8(25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e15(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e8(27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e24(16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e3(9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e10(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e3(10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e32(22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e17(53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e21(41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e14(28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003epTNM stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e7(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e21(14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e42(29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e3(9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e7(13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e3(10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.196605374823196%\" valign=\"bottom\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.558698727015559%\" valign=\"bottom\"\u003e\n \u003cp\u003e72(50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.305516265912306%\" valign=\"bottom\"\u003e\n \u003cp\u003e28(87.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.325318246110326%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.263083451202263%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e43(84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.295615275813295%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e25(86.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75954738330976%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: HIPEC, hyperthermic intraperitoneal chemotherapy; BMI, body mass index; ASA, American society of anesthesiologists physical status classification.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"729\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"98.21428571428571%\" colspan=\"11\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable2. Comparison of postoperative recurrence and metastasis in the two groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.7857142857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.77472527472528%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.159340659340659%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.752747252747255%\" colspan=\"5\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter propensitymatching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.7857142857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSites\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-HIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.159340659340659%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.934065934065934%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-HIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.340659340659341%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIPEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.7857142857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=142)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.159340659340659%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.934065934065934%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=51)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.340659340659341%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.7857142857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocal regions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e134（94.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e30（93.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e49（96.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e28（96.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e8（5.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e2（6.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e2（3.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeritoneum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e118（83.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e28（87.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e38（74.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e27（93.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e24（16.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e4（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e13（25.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e2（6.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e136（95.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e31（96.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e48（94.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e28（96.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e6（4.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e3（5.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e136（95.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e32（100.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e47（92.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e29（100.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e6（4.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e4（7.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e0（0.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther distal organs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e137（96.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e31（96.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e50（98.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e28（96.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e5（3.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1（2.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e138（97.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e31（96.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e49（96.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e28（96.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e4（2.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e2（3.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e1（3.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymph node\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e130（91.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e30（93.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e46（90.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e27（93.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e12（8.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e2（6.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e5（9.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e2（6.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e77（54.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e21（65.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e21（41.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e21（72.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.10989010989011%\" valign=\"bottom\"\u003e\n \u003cp\u003e65（45.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.637362637362637%\" valign=\"bottom\"\u003e\n \u003cp\u003e11（34.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.027472527472527%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.197802197802198%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.873626373626374%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e30（58.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.148351648351648%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e8（27.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.478021978021978%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"12\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: HIPEC, hyperthermic intraperitoneal chemotherapy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"neoadjuvant chemotherapy, laparoscopic surgery, hyperthermic intraperitoneal chemotherapy, gastric cancer","lastPublishedDoi":"10.21203/rs.3.rs-4461027/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4461027/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eClinical T4 (cT4) stage gastric cancer presents with frequent postoperative recurrence and poor prognosis. This study is to evaluate the oncological efficacy of laparoscopic radical total gastrectomy combined with postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with cT4N\u0026thinsp;+\u0026thinsp;M0 gastric cancer who received neoadjuvant chemotherapy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We reviewed the clinicopathological data of 174 patients with clinical T4 gastric cancer who underwent neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy between June 2017 and December 2021. Among them, 142 were included in the non-HIPEC group, and 32 in the HIPEC group. Patients in both groups were paired based on propensity score in a 2:1 ratio to assess disparities in tumor recurrence and long-term survival.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter matching, there were no significant differences in the clinicopathological data between the two groups. The peritoneum (16.1%) and distant organs (10.9%) were the most frequent locations for recurrence. Prior to matching, the recurrence rates were similar at all sites for both groups. Compared with those in the non-HIPEC cohort, the recurrence rates at all sites, the lung, and the peritoneum were notably lower in the HIPEC cohort. Prior to matching, the 3-year overall survival and disease-free survival rates were similar between the two groups; following matching, the HIPEC group exhibited notably greater survival rates than did the non-HIPEC group. The disparities in survival rates between the groups became even more pronounced after conducting a stratified analysis among patients with stage III disease.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNeoadjuvant chemotherapy combined with prophylactic HIPEC after laparoscopic radical gastrectomy can effectively reduce the rate of peritoneal metastasis in patients with cT4N\u0026thinsp;+\u0026thinsp;M0 advanced gastric cancer and significantly improve the prognosis of such patients, which is of great clinical value.\u003c/p\u003e","manuscriptTitle":"Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-12 03:38:09","doi":"10.21203/rs.3.rs-4461027/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-26T04:22:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-25T06:52:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-25T00:23:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-21T08:34:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266420921530446097387574589506048241363","date":"2024-07-20T16:48:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79336366092855742516970348545632818227","date":"2024-07-19T21:26:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219129582833840884478196269163714559130","date":"2024-07-16T14:05:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304564807919134548372352604087705307852","date":"2024-07-15T15:05:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-09T09:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279636404066532165786510256008305337820","date":"2024-07-08T06:25:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6581014080705784643219486265270318270","date":"2024-07-05T02:24:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32447901330378463969835667726706014688","date":"2024-07-03T15:24:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297370348501988451081401142010930629125","date":"2024-06-08T07:05:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-05T08:19:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-01T03:52:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-27T23:32:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Surgical Oncology","date":"2024-05-22T12:50:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3145b166-e748-4f48-850e-1fdc424cb5df","owner":[],"postedDate":"June 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:01:04+00:00","versionOfRecord":{"articleIdentity":"rs-4461027","link":"https://doi.org/10.1186/s12957-024-03526-y","journal":{"identity":"world-journal-of-surgical-oncology","isVorOnly":false,"title":"World Journal of Surgical Oncology"},"publishedOn":"2024-09-11 15:57:25","publishedOnDateReadable":"September 11th, 2024"},"versionCreatedAt":"2024-06-12 03:38:09","video":"","vorDoi":"10.1186/s12957-024-03526-y","vorDoiUrl":"https://doi.org/10.1186/s12957-024-03526-y","workflowStages":[]},"version":"v1","identity":"rs-4461027","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4461027","identity":"rs-4461027","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}