Efficacy of Postoperative Chemotherapy After Resection that Leaves No Macroscopically Visible Disease of Gastric Cancer with Positive Peritoneal Lavage Cytology (CY1) or Localized Peritoneum Metastasis (P1a): A Multicenter Retrospective Study

  • Toshifumi Yamaguchi
  • Atsuo TakashimaEmail author
  • Kengo Nagashima
  • Rie Makuuchi
  • Masaki Aizawa
  • Manabu Ohashi
  • Keitaro Tashiro
  • Tatsuya Yamada
  • Takahiro Kinoshita
  • Hiroaki Hata
  • Yasuyuki Kawachi
  • Ryohei Kawabata
  • Toshikatsu Tsuji
  • Jun Hihara
  • Takeshi Sakamoto
  • Takeo Fukagawa
  • Hitoshi Katai
  • Kazuhide Higuchi
  • Narikazu Boku
Peritoneal Surface Malignancy



Gastric cancer (GC) patients with positive peritoneal lavage cytology (CY1) and/or localized peritoneum metastasis (P1a) are defined as stage IV in the 15th edition of the Japanese Classification of Gastric Cancer. In Japan, the most common treatment for patients with CY1 and/or P1a is gastrectomy followed by postoperative chemotherapy.

Patients and Methods

Subjects in this multi-institutional retrospective study were GC patients with CY1 and/or P1a who received surgical resection that leaves no macroscopically visible disease. Patients were selected from 34 institutions in Japan between 2007 and 2012. Selection criteria included adenocarcinoma, no distant metastasis except CY1 and P1a, and no prior treatment for GC before surgery.


Among 824 patients registered, 506 were identified as eligible, with a background of P0CY1, P1aCY0, or P1aCY1 (72.5%, 16.0%, and 11.5% of subjects, respectively). Sixty-two patients had not received postoperative chemotherapy (no-Cx), whereas 444 patients had received postoperative chemotherapy: S-1 monotherapy (S-1; n = 267, 52.7%), cisplatin plus S-1 (CS; n = 114, 22.5%), and others (n = 63, 12.6%). Overall survival (OS) was 29.5, 24.7, 25.4 and 9.9 months in the S-1, CS, ‘others’, and no-Cx groups, respectively [CS vs. S-1: hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.89–1.50; p = 0.275]. In multivariate analysis, OS was similar between the S-1 and CS groups (CS vs. S-1: HR 1.19, 95% CI 0.92–1.55; p = 0.18).


Postoperative chemotherapy after gastrectomy that leaves no macroscopically visible disease may have some survival benefits for GC patients with CY1 and/or P1a. In contrast, S-1 plus cisplatin seems to have no additional benefit over S-1 treatment alone.



Toshifumi Yamaguchi, Atsuo Takashima, Kengo Nagashima, Rie Makuuchi, Masaki Aizawa, Manabu Ohashi, Keitaro Tashiro, Tatsuya Yamada, Takahiro Kinoshita, Hiroaki Hata, Yasuyuki Kawachi, Ryohei Kawabata, Toshikatsu Tsuji, Jun Hihara, Takeshi Sakamoto, Takeo Fukagawa, Hitoshi Katai, Kazuhide Higuchi, and Narikazu Boku have no conflicts of interest to declare.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Toshifumi Yamaguchi
    • 1
    • 2
  • Atsuo Takashima
    • 2
    Email author
  • Kengo Nagashima
    • 3
  • Rie Makuuchi
    • 4
  • Masaki Aizawa
    • 5
  • Manabu Ohashi
    • 6
  • Keitaro Tashiro
    • 7
  • Tatsuya Yamada
    • 8
  • Takahiro Kinoshita
    • 9
  • Hiroaki Hata
    • 10
  • Yasuyuki Kawachi
    • 11
  • Ryohei Kawabata
    • 12
  • Toshikatsu Tsuji
    • 13
  • Jun Hihara
    • 14
  • Takeshi Sakamoto
    • 15
  • Takeo Fukagawa
    • 16
  • Hitoshi Katai
    • 17
  • Kazuhide Higuchi
    • 1
  • Narikazu Boku
    • 2
  1. 1.Cancer Chemotherapy Center and Second Department of Internal MedicineOsaka Medical CollegeOsakaJapan
  2. 2.Gastrointestinal Oncology DivisionNational Cancer Center HospitalTokyoJapan
  3. 3.Research Center for Medical and Health Data ScienceThe Institute of Statistical MathematicsTokyoJapan
  4. 4.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
  5. 5.Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
  6. 6.Department of Gastroenterological SurgeryCancer Institute HospitalTokyoJapan
  7. 7.Departments of General and Gastroenterological SurgeryOsaka Medical College HospitalOsakaJapan
  8. 8.Department of Gastroenterological SurgerySaitama Cancer CenterSaitamaJapan
  9. 9.Gastric Surgery DivisionNational Cancer Center Hospital EastKashiwaJapan
  10. 10.Department of SurgeryNational Hospital Organization Kyoto Medical CenterKyotoJapan
  11. 11.Department of SurgeryNagaoka Chuo General HospitalNiigataJapan
  12. 12.Department of SurgeryOsaka Rosai HospitalOsakaJapan
  13. 13.Department of Gastroenterological SurgeryIshikawa Prefectural Central HospitalKanazawaJapan
  14. 14.Department of SurgeryHiroshima City Asa Citizens HospitalHiroshimaJapan
  15. 15.Department of GastroenterologyHyogo Cancer CenterHyogoJapan
  16. 16.Department of SurgeryTeikyo University HospitalTokyoJapan
  17. 17.Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan

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