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.
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.
Authors: Jason S Gold; David P Jaques; David J Bentrem; Manish A Shah; Laura H Tang; Murray F Brennan; Daniel G Coit Journal: Ann Surg Oncol Date: 2007-02 Impact factor: 5.344
Authors: E Bando; Y Yonemura; Y Takeshita; K Taniguchi; T Yasui; Y Yoshimitsu; S Fushida; T Fujimura; G Nishimura; K Miwa Journal: Am J Surg Date: 1999-09 Impact factor: 2.565
Authors: Ian Chau; Andy R Norman; David Cunningham; Justin S Waters; Jacqui Oates; Paul J Ross Journal: J Clin Oncol Date: 2004-06-15 Impact factor: 44.544
Authors: Sara Jamel; Sheraz R Markar; George Malietzis; Amish Acharya; Thanos Athanasiou; George B Hanna Journal: Gastric Cancer Date: 2017-08-04 Impact factor: 7.370
Authors: Rune B Strandby; Lars B Svendsen; Rikard Ambrus; Andreas A Rostved; Jane P Hasselby; Michael P Achiam Journal: J Cytol Date: 2019-12-23 Impact factor: 1.000