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Surgery Today

, Volume 49, Issue 1, pp 56–64 | Cite as

Prognostic factors for cytology-positive gastric cancer

  • Shunji Endo
  • Masakazu Ikenaga
  • Katsuya Ohta
  • Masami Ueda
  • Yujiro Tsuda
  • Ryo Kato
  • Hiroaki Itakura
  • Jin Matsuyama
  • Kazuhiro Nishikawa
  • Terumasa YamadaEmail author
Original Article
  • 163 Downloads

Abstract

Purpose

Positive peritoneal lavage cytology for gastric carcinoma cells (CY1) is considered distant metastasis and is classified as Stage IV. However, patients with CY1 comprise a heterogeneous population, and their prognosis varies greatly. The prognostic factors for gastric cancer patients with CY1 were retrospectively reviewed.

Methods

The participants were 80 gastric cancer patients with CY1 in our institution encountered between 2005 and 2017. Prognostic factors were analyzed using univariate and multivariate analyses.

Results

The operative procedure was distal gastrectomy for 30 patients, total gastrectomy for 27 patients, staging laparoscopy for 10 patients, gastrojejunostomy for 8 patients, and probe laparotomy for 5 patients. Other distant metastases were recognized in 36 patients. A multivariate analysis revealed that other distant metastases were the strongest independent risk factor for the overall survival (p < 0.0001). When the cohort was limited to CY1 patients without other distant metastases, cN2–3 (p = 0.01), the prognostic nutritional index (PNI) < 40 (p = 0.02) and Type 4 (p = 0.03) were independent risk factors according to a multivariate analysis. The survivals of patients with cN2–3 or PNI < 40 after gastrectomy were equivalent to those with other distant metastases, as assessed by log-rank analyses.

Conclusions

The prognoses of CY1 gastric cancer patients with cN2–3 or PNI < 40 were poor, even after gastrectomy.

Keywords

Stomach neoplasms Abdominal lavage cytology Lymph node metastasis 

Notes

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest.

References

  1. 1.
    Cancer Information Service, National Cancer Center, Japan. Cancer Registry and Statistics. https://ganjoho.jp/reg_stat/statistics/dl/index.html#mortality Accessed 1 Apr 2018.
  2. 2.
    Japanese Gastric Cancer Association. The Japanese gastric cancer registry in 2009. http://www.jgca.jp/entry/iganhtml/doc/2009_report.pdf Accessed 1 Apr 2018.
  3. 3.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, the 15th edition (in Japanese). Tokyo: Kanehara; 2017.Google Scholar
  4. 4.
    Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, the eighth edition. Oxford: Wiley Blackwell; 2017.Google Scholar
  5. 5.
    Association Japanese Gastric Cancer. Gastric Cancer Treatment Guidelines, 5th ed. Tokyo: Kanehara; 2018 (in Japanese).Google Scholar
  6. 6.
    Kodera Y, Ito S, Mochizuki Y, Kondo K, Koshikawa K, Suzuki N, et al. A phase II study of radical surgery followed by postoperative chemotherapy with S-1 for gastric carcinoma with free cancer cells in the peritoneal cavity (CCOG0301 study). Eur J Surg Oncol. 2009;35:1158–63.CrossRefGoogle Scholar
  7. 7.
    Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients (in Japanese with English abstract). Nihon Geka Gakkai Zasshi (J Jpn Surg Society). 1984;85:1001–5.Google Scholar
  8. 8.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 1982;5:649–55.CrossRefGoogle Scholar
  9. 9.
    American Society of Anesthesiologists. ASA physical status classification system. https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system Accessed 1 Apr 2018.
  10. 10.
    Lee SD, Ryu KW, Eom BW, Lee JH, Kook MC, Kim YW, et al. Prognostic significance of peritoneal washing cytology in patients with gastric cancer. Br J Surg. 2012;99:397–403.CrossRefGoogle Scholar
  11. 11.
    Yoshida K, Yamaguchi K, Okumura N, Tanahashi T, Kodera Y. Is conversion therapy possible in stage IV gastric cancer: the proposal of new biological categories of classification. Gastric Cancer. 2016;19:329–38.CrossRefGoogle Scholar
  12. 12.
    Nakagohri T, Yoneyama Y, Kinoshita T, Konishi M, Inoue K, Takahashi S. Prognostic significance of peritoneal washing cytology in patients with potentially resectable gastric cancer. Hepatogastroenterology. 2008;55:1913–5.PubMedGoogle Scholar
  13. 13.
    Nishikawa K, Fujitani K, Endo S, Kawada J, Hirao M, Hamakawa T, et al. Is gastrectomy for CY1 gastric cancer truly essential? [abstract]. In 90th Annual Meeting of the Japanese Gastric Cancer Association program: 2018 Mar 7–9: Yokohama. Japan: Abstract PP230.Google Scholar
  14. 14.
    Fujitani K, Yang HK, Mizusawa J, Kim YW, Terashima M, Han SU, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–18.CrossRefGoogle Scholar
  15. 15.
    Yamamoto M, Kawano H, Yamaguchi S, Egashira A, Minami K, Taguchi K, et al. Comparison of neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy in Japanese patients with peritoneal lavage cytology positive for gastric carcinoma. Anticancer Res. 2015;35:4859–63.PubMedGoogle Scholar
  16. 16.
    Fukuchi M, Mochiki E, Ishiguro T, Ogura T, Sobajima J, Kumagai Y, et al. Prognostic factors for gastric cancer with cancer cells in the peritoneal cavity. Anticancer Res. 2016;36:2481–5.CrossRefGoogle Scholar
  17. 17.
    Kano K, Aoyama T, Maezawa Y, Nakajima T, Ikeda K, Yamada T, et al. The survival and prognosticators of peritoneal cytology-positive gastric cancer patients who received upfront gastrectomy and subsequent S-1 chemotherapy. Int J Clin Oncol. 2017;22:887–96.CrossRefGoogle Scholar
  18. 18.
    Saito H, Kihara K, Kuroda H, Matsunaga T, Tatebe S, Ikeguchi M. Surgical outcomes for gastric cancer patients with intraperitoneal free cancer cell, but no macroscopic peritoneal metastasis. J Surg Oncol. 2011;104:534–7.CrossRefGoogle Scholar
  19. 19.
    Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014;101:653–60.CrossRefGoogle Scholar
  20. 20.
    Noda S, Yashiro M, Toyokawa T, Morimoto J, Shinto O, Muguruma K. Borrmann’s macroscopic criteria and p-Smad2 expression are useful predictive prognostic markers for cytology-positive gastric cancer patients without overt peritoneal metastasis. Ann Surg Oncol. 2011;18:3718–25.CrossRefGoogle Scholar
  21. 21.
    Fukagawa T, Katai H, Saka M, Morita S, Sasajima Y, Taniguchi H, et al. Significance of lavage cytology in advanced gastric cancer patients. World J Surg. 2010;34(3):563–8.CrossRefGoogle Scholar
  22. 22.
    Kano Y, Kosugi S, Ishikawa T, Otani T, Muneoka Y, Sato Y, et al. Prognostic significance of peritoneal lavage cytology at three cavities in patients with gastric cancer. Surgery. 2015;158:1581–9.CrossRefGoogle Scholar
  23. 23.
    Nishimura T, Iwasa S, Nagashima K, Okita N, Takashima A, Honma Y, et al. Irinotecan monotherapy as third-line treatment for advanced gastric cancer refractory to fluoropyrimidines, platinum, and taxanes. Gastric Cancer. 2017;20:655–62.CrossRefGoogle Scholar
  24. 24.
    Crumley AB, Stuart RC, McKernan M, McMillan DC. Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg. 2010;34:2393–8.CrossRefGoogle Scholar
  25. 25.
    Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6:41370–82.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Shunji Endo
    • 1
  • Masakazu Ikenaga
    • 1
  • Katsuya Ohta
    • 1
  • Masami Ueda
    • 1
  • Yujiro Tsuda
    • 1
  • Ryo Kato
    • 1
  • Hiroaki Itakura
    • 1
  • Jin Matsuyama
    • 2
  • Kazuhiro Nishikawa
    • 3
  • Terumasa Yamada
    • 1
    Email author
  1. 1.Department of Gastroenterological SurgeryHigashiosaka City Medical CenterHigashiosakaJapan
  2. 2.Department of SurgeryYao Municipal HospitalOsakaJapan
  3. 3.Department of SurgeryNational Hospital Organization Osaka National HospitalOsakaJapan

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