Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Academic Article uri icon

Overview

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.

publication date

  • June 29, 2010

Research

keywords

  • Neoplasm Recurrence, Local
  • Peritoneal Lavage
  • Peritoneal Neoplasms
  • Peritoneum
  • Stomach Neoplasms

Identity

Scopus Document Identifier

  • 78650996568

Digital Object Identifier (DOI)

  • 10.1245/s10434-010-1183-0

PubMed ID

  • 20585870

Additional Document Info

volume

  • 17

issue

  • 12