Tumor Biology

, Volume 35, Issue 4, pp 3261–3268 | Cite as

Clinicopathological characteristics and prognosis of gastric cancer with malignant ascites

  • Nian Fang
  • Hui-Qing Zhang
  • Bo He
  • Mei Xie
  • Shan Lu
  • Yi-Ye Wan
  • Nong-Rong Wang
Research Article

Abstract

Management of gastric cancer with malignant ascites is a challenge, and limited data are available. We evaluated factors affecting survival for this condition to determine factors that predict survival outcome and to develop a rational treatment plan. We retrospectively studied 5,542 patients with gastric adenocarcinoma from January 2007 to December 2012. Among them, 347 patients (6.26 %) were associated with malignant ascites. The patients’ overall survival was compared among the different features. Three hundred forty-seven patients (153 females and 194 males; median age, 53 years) were enrolled, including 78 (22.5 %) young patients and 63 (18.1 %) elderly patients. One hundred forty-three (41.2 %) patients presented with malignant ascites at the initial diagnosis of gastric cancer, and 211 (60.8 %) received chemotherapy. After a median follow-up duration of 10.4 months, the median survival after the diagnosis of malignant ascites was 5.2 months (95 % CI, 4.8–5.6 months), and the 1-year survival rate was 16.1 %. An ECOG score greater than 2 (P < 0.001), the presence of ascites with the diagnosis of gastric cancer (P < 0.001), no chemotherapy (P < 0.001), an albumin level less than 30 g/L (P = 0.013), an ascites volume greater than 2,000 mL (P = 0.019), Helicobacter pylori infection (P = 0.010), and metastases to other organs (P = 0.037) were associated with poor prognosis, and they were all independent prognostic factors. The survival of gastric cancer patients with malignant ascites is relatively short, and ECOG score and the presence of ascites with the diagnosis of gastric cancer are the most important prognostic factors. Additionally, chemotherapy could improve the overall survival.

Keywords

Malignant ascites Gastric cancer Prognosis Survival Chemotherapy 

Notes

Conflicts of interest

None

References

  1. 1.
    Parsons SL, Watson SA, Steele RJ. Malignant ascites. Br J Surg. 1996;83(1):6–14. doi: 10.1002/bjs.1800830104.PubMedCrossRefGoogle Scholar
  2. 2.
    Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330(5):337–42. doi: 10.1056/NEJM199402033300508.PubMedCrossRefGoogle Scholar
  3. 3.
    Aslam N, Marino CR. Malignant ascites: new concepts in pathophysiology, diagnosis, and management. Arch Intern Med. 2001;161(22):2733–7. doi: 10.1001/archinte.161.22.2733.PubMedCrossRefGoogle Scholar
  4. 4.
    Ayantunde AA, Parsons SL. Pattern and prognostic factors in patients with malignant ascites: a retrospective study. Ann Oncol. 2007;18(5):945–9. doi: 10.1093/annonc/mdl499.PubMedCrossRefGoogle Scholar
  5. 5.
    Wimberger P, Gilet H, Gonschior AK, Heiss MM, Moehler M, Oskay-Oezcelik G, et al. Deterioration in quality of life (QoL) in patients with malignant ascites: results from a phase II/III study comparing paracentesis plus catumaxomab with paracentesis alone. Ann Oncol. 2012;23(8):1979–85. doi: 10.1093/annonc/mds178.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42(5):589–97. doi: 10.1016/j.ejca.2005.11.018.PubMedCrossRefGoogle Scholar
  7. 7.
    Cavazzoni E, Bugiantella W, Graziosi L, Franceschini MS, Donini A. Malignant ascites: pathophysiology and treatment. Int J Clin Oncol. 2013;18(1):1–9. doi: 10.1007/ s10147 -012-0396-6.PubMedCrossRefGoogle Scholar
  8. 8.
    Imamoto H, Oba K, Sakamoto J, Iishi H, Narahara H, Yumiba T, et al. Assessing clinical benefit response in the treatment of gastric malignant ascites with non-measurable lesions: a multicenter phase II trial of paclitaxel for malignant ascites secondary to advanced/recurrent gastric cancer. Gastric Cancer. 2011;14(1):81–90.PubMedCrossRefGoogle Scholar
  9. 9.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. doi: 10.3322/caac.20107.PubMedCrossRefGoogle Scholar
  10. 10.
    Oriuchi N, Nakajima T, Mochiki E, Takeyoshi I, Kanuma T, Endo K, et al. A new, accurate and conventional five-point method for quantitative evaluation of ascites using plain computed tomography in cancer patients. Jpn J Clin Oncol. 2005;35(7):386–90. doi: 10.1093/jjco/hyi109.PubMedCrossRefGoogle Scholar
  11. 11.
    Parsons SL, Lang MW, Steele RJ. Malignant ascites: a 2-year review from a teaching hospital. Eur J Surg Oncol. 1996;22(3):237–9. doi: 10.1016/S0748-7983(96)80009-6.PubMedCrossRefGoogle Scholar
  12. 12.
    Mackey JR, Venner PM. Malignant ascites: demographics, therapeutic efficacy and predictors of survival. Can J Oncol. 1996;6(2):474–80.PubMedGoogle Scholar
  13. 13.
    Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 2013;16(1):1–27. doi: 10.1007/s10120-012-0163-4.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ishigami H, Kitayama J, Kaisaki S, Hidemura A, Kato M, Otani K, et al. Phase II study of weekly intravenous and intraperitoneal paclitaxel combined with S-1 for advanced gastric cancer with peritoneal metastasis. Ann Oncol. 2010;21(1):67–70. doi: 10.1093/annonc/mdp260.PubMedCrossRefGoogle Scholar
  15. 15.
    Lee J, Lim T, Uhm JE, Park KW, Park SH, Lee SC, et al. Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma. Ann Oncol. 2007;18(5):886–91. doi: 10.1093/annonc/mdl501.PubMedCrossRefGoogle Scholar
  16. 16.
    Mansour-Ghanaei F, Shafaghi A, Bagherzadeh AH, Fallah MS. Low gradient ascites: a seven-year course review. World J Gastroenterol. 2005;11(15):2337–9.PubMedGoogle Scholar
  17. 17.
    Powell J, McConkey CC. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer. 1990;62(3):440–3. doi: 10.1038/bjc.1990.314.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Janjigian YY, Werner D, Pauligk C, Steinmetz K, Kelsen DP, Jäger E, et al. Prognosis of metastatic gastric and gastroesophageal junction cancer by HER2 status: a European and USA International collaborative analysis. Ann Oncol. 2012;23(10):2656–62. doi: 10.1093/annonc/mds104.PubMedCrossRefGoogle Scholar
  19. 19.
    Emoto S, Ishigami H, Yamashita H, Yamaguchi H, Kaisaki S, Kitayama J. Clinical significance of CA125 and CA72-4 in gastric cancer with peritoneal dissemination. Gastric Cancer. 2012;15(2):154–61. doi: 10.1007/s10120-011-0091-8.PubMedCrossRefGoogle Scholar
  20. 20.
    Ramos-De la Medina A, Salgado-Nesme N, Torres-Villalobos G, Medina-Franco H. Clinicopathologic characteristics of gastric cancer in a young patient population. J Gastrointest Surg. 2004;8(3):240–4. doi: 10.1016/j.gassur.2003.12.009.PubMedCrossRefGoogle Scholar
  21. 21.
    Lai JF, Kim S, Li C, Oh SJ, Hyung WJ, Choi WH, et al. Clinicopathologic characteristics and prognosis for young gastric adenocarcinoma patients after curative resection. Ann Surg Oncol. 2008;15(5):1464–9. doi: 10.1245/s10434-008-9809-1.PubMedCrossRefGoogle Scholar
  22. 22.
    Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Clinicopathological features of gastric carcinoma in younger and middle-aged patients: a comparative study. J Gastrointest Surg. 2006;10(7):1023–32. doi: 10.1016/j.gassur. 2006. 03.001.PubMedCrossRefGoogle Scholar
  23. 23.
    Santoro R, Carboni F, Lepiane P, Ettorre GM, Santoro E. Clinicopathological features and prognosis of gastric cancer in young European adults. Br J Surg. 2007;94(6):737–42. doi: 10.1002/bjs.5600.PubMedCrossRefGoogle Scholar
  24. 24.
    Warren JR, Marshall BJ. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1983;1(8336):1273–5.Google Scholar
  25. 25.
    Asaka M. A new approach for elimination of gastric cancer deaths in Japan. Int J Cancer. 2013;132(6):1272–6. doi: 10.1002/ijc.27965.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008;372(9636):392–7. doi: 10.1016/S0140-6736(08)61159-9.PubMedCrossRefGoogle Scholar
  27. 27.
    Meimarakis G, Winter H, Assmann I, Kopp R, Lehn N, Kist M, et al. Helicobacter pylori as a prognostic indicator after curative resection of gastric carcinoma: a prospective study. Lancet Oncol. 2006;7(3):211–22. doi: 10.1016/S1470-2045(06)70586-1.PubMedCrossRefGoogle Scholar
  28. 28.
    Qiu HB, Zhang LY, Keshari RP, Wang GQ, Zhou ZW, Xu DZ, et al. Relationship between H. pylori infection and clinicopathological features and prognosis of gastric cancer. BMC Cancer. 2010;10:374. doi: 10.1186/1471-2407-10-374.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Chen HY, Zhu BH, Zhang CH, Yang DJ, Peng JJ, Chen JH, et al. High CpG island methylator phenotype is associated with lymph node metastasis and prognosis in gastric cancer. Cancer Sci. 2012;103(1):73–9. doi: 10.1111/j.1349-7006.2011.02129.x.PubMedCrossRefGoogle Scholar
  30. 30.
    Tamegai H, Kaiga T, Kochi M, Fujii M, Kanamori N, Mihara Y, et al. Pharmacokinetics of docetaxel in gastric cancer patients with malignant ascites. Cancer Chemother Pharmacol. 2013;71(3):727–31. doi: 10.1007/s00280-012-2066-9.PubMedCrossRefGoogle Scholar
  31. 31.
    Heiss MM, Murawa P, Koralewski P, Kutarska E, Kolesnik OO, Ivanchenko VV, et al. The trifunctional antibody catumaxomab for the treatment of malignant ascites due to epithelial cancer: results of a prospective randomized phase II/III trial. Int J Cancer. 2010;127(9):2209–21. doi: 10.1002/ijc.25423.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2013

Authors and Affiliations

  • Nian Fang
    • 1
  • Hui-Qing Zhang
    • 2
  • Bo He
    • 2
  • Mei Xie
    • 3
  • Shan Lu
    • 2
  • Yi-Ye Wan
    • 2
  • Nong-Rong Wang
    • 1
  1. 1.Gastrointestinal Department of Internal MedicineThe Fourth Affiliated Hospital of Nanchang UniversityNanchangChina
  2. 2.The Third Department of Medical OncologyJiangxi Provincial Cancer HospitalNanchangChina
  3. 3.The Cytology LaboratoryJiangxi Provincial Cancer HospitalNanchangChina

Personalised recommendations