Shunji Endo1, Kazuhiro Nishikawa2, Masakazu Ikenaga3, Kazumasa Fujitani4, Junji Kawada5, Tomoki Yamatsuji6, Hisako Kubota7, Masaharu Higashida7, Yoshinori Fujiwara7, Tomio Ueno7. 1. Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama, 701-0192, Japan. shunji.endo@hosp-yao.osaka.jp. 2. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 3. Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Osaka, Japan. 4. Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan. 5. Department of Surgery, Yao Municipal Hospital, Osaka, Japan. 6. Department of General Surgery, Kawasaki Medical School, Okayama, Japan. 7. Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama, 701-0192, Japan.
Abstract
BACKGROUND: The prognosis of patients with gastric cancer and positive peritoneal lavage cytology is poor, even after gastrectomy. Though the standard therapy for this population is radical gastrectomy followed by S-1 chemotherapy, treatments vary among institutions and eras. We conducted a multicenter retrospective study to investigate the prognostic factors for cytology-positive gastric cancer. METHODS: We reviewed the medical records obtained from 6 institutions, covering 2000-2019. There were 128 patients with positive cytology and no other distant metastases that underwent R1 gastrectomy. Univariate and multivariate analyses to identify prognostic factors for overall survival were conducted using Cox's proportional hazards models. RESULTS: The median overall survival time was 18.6 months. In univariate analyses, age (≥ 80 years vs. < 70 years), performance status (2, 3 vs. 0), prognostic nutritional index (< 35 vs. ≥ 40), the extent of lymphadenectomy (D1 vs. ≥ D2), macroscopic type (type 4 vs. non-type 4), and postoperative chemotherapy (none vs. S-1) were significantly correlated with worse survival. Multivariate analysis revealed that lymph node metastasis (pN3b vs. pN0, hazard ratio 4.46, 95% confidence interval 1.17-16.9, p = 0.03) and postoperative chemotherapy (none vs. S-1, hazard ratio 2.28, 95% confidence interval 1.16-4.45, p = 0.02) were independent risk factors for death. No postoperative chemotherapy regimen showed a survival benefit over S-1 monotherapy. CONCLUSIONS: Massive lymph node metastasis was an independent risk factor in cytology-positive gastric cancer. Postoperative chemotherapy was also an independent prognostic factor, though the most beneficial regimen was still uncertain.
BACKGROUND: The prognosis of patients with gastric cancer and positive peritoneal lavage cytology is poor, even after gastrectomy. Though the standard therapy for this population is radical gastrectomy followed by S-1 chemotherapy, treatments vary among institutions and eras. We conducted a multicenter retrospective study to investigate the prognostic factors for cytology-positive gastric cancer. METHODS: We reviewed the medical records obtained from 6 institutions, covering 2000-2019. There were 128 patients with positive cytology and no other distant metastases that underwent R1 gastrectomy. Univariate and multivariate analyses to identify prognostic factors for overall survival were conducted using Cox's proportional hazards models. RESULTS: The median overall survival time was 18.6 months. In univariate analyses, age (≥ 80 years vs. < 70 years), performance status (2, 3 vs. 0), prognostic nutritional index (< 35 vs. ≥ 40), the extent of lymphadenectomy (D1 vs. ≥ D2), macroscopic type (type 4 vs. non-type 4), and postoperative chemotherapy (none vs. S-1) were significantly correlated with worse survival. Multivariate analysis revealed that lymph node metastasis (pN3b vs. pN0, hazard ratio 4.46, 95% confidence interval 1.17-16.9, p = 0.03) and postoperative chemotherapy (none vs. S-1, hazard ratio 2.28, 95% confidence interval 1.16-4.45, p = 0.02) were independent risk factors for death. No postoperative chemotherapy regimen showed a survival benefit over S-1 monotherapy. CONCLUSIONS: Massive lymph node metastasis was an independent risk factor in cytology-positive gastric cancer. Postoperative chemotherapy was also an independent prognostic factor, though the most beneficial regimen was still uncertain.
Authors: Makoto Yamasaki; S Takiguchi; T Omori; M Hirao; H Imamura; K Fujitani; S Tamura; Y Akamaru; K Kishi; J Fujita; T Hirao; K Demura; J Matsuyama; A Takeno; C Ebisui; K Takachi; O Takayama; H Fukunaga; K Okada; S Adachi; S Fukuda; N Matsuura; T Saito; T Takahashi; Y Kurokawa; M Yano; H Eguchi; Y Doki Journal: Gastric Cancer Date: 2020-10-29 Impact factor: 7.370