Positive peritoneal cytology in patients with gastric cancer: Natural history and outcome of 291 patients Journal Article
| Authors: | Mezhir, J. J.; Shah, M. A.; Jacks, L.; Brennan, M. F.; Coit, D. G.; Strong, V. |
| Article Title: | Positive peritoneal cytology in patients with gastric cancer: Natural history and outcome of 291 patients |
| Abstract: | Background: Positive peritoneal cytology is a predictor of poor survival in patients with gastric cancer. Our aim is to more clearly define the natural history of this cohort. Methods: Review of a prospectively maintained gastric cancer database of patients who had diagnostic laparoscopy with peritoneal washings. Clinicopathologic and treatment-related variables were obtained. Univariate and multivariate analyses were performed for factors associated with disease-specific survival (DSS). Results: From January 1993 to April 2009, a total of 1241 patients with gastric cancer underwent laparoscopy with peritoneal washings; 291 (23%) had positive cytology. There were 198 patients (68%) who had visible metastases discovered at laparoscopy (M1), and 93 patients (32%) were without gross evidence of advanced disease (M1 Cyt+). The median DSS for the entire cohort was 1 year; for M1, DSS was 0.8 years, and for M1 Cyt+, DSS was 1.3 years. At baseline, independent predictors of worse DSS were poor performance status, M1 disease, and diffuse tumors. Among the subset of patients with M1 Cyt+ disease, performance status was the strongest independent predictor of DSS. A total of 48 of the 291 Cyt+ patients had repeat staging laparoscopy after chemotherapy. Compared with patients who had persistently positive cytology (n = 21), those who converted to negative cytology (n = 27) had a significant improvement in DSS (2.5 years vs. 1.4 years, P = 0.0003). Conclusions: Patients with positive cytology as the only evidence of advanced disease exhibit a poor outcome; however, clearing of Cyt+ disease by chemotherapy is associated with a statistically significant improvement in DSS. The role for gastrectomy in patients with positive peritoneal cytology remains uncertain. © 2010 Society of Surgical Oncology. |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; aged; major clinical study; cisplatin; laparoscopy; prospective study; gastrectomy; stomach cancer; visceral metastasis; ascites fluid cytology; peritoneal disease; stomach lavage |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 17 |
| Issue: | 12 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2010-12-01 |
| Start Page: | 3173 |
| End Page: | 3180 |
| Language: | English |
| DOI: | 10.1245/s10434-010-1183-0 |
| PROVIDER: | scopus |
| PUBMED: | 20585870 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: ASONF" - "Source: Scopus" |
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