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
- 133 Downloads
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.
- 1.International Agency for Research on Cancer. GLOBOCAN 2012: cancer incidence and mortality worldwide. http://globocan.iarc.fr/Default.aspx. Accessed 21 Aug 2018.
- 2.Center for Cancer Control and Information Services, National Cancer Canter, Japan. http://ganjoho.ncc.go.jp/public/statistics/pub/statistics06.html.
- 5.Nakajima T, Harashima S, Hirata M, Kajitani T. Prognostic and therapeutic values of peritoneal cytology in gastric cancer. Acta Cytol. 1978; 22:225–29.Google Scholar
- 7.Kodera Y, Nakanishi H, Ito S, Yamamura Y, Fujiwara M, Koike M. Prognostic significance of intraperitoneal cancer cells in gastric carcinoma: detection of cytokeratin 20 mRNA in peritoneal washes, in addition to detection of carcinoembryonic antigen. Gastric Cancer. 2005; 8:142–8.CrossRefGoogle Scholar
- 9.Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1998; 1:10–24.Google Scholar
- 13.Nakayama I, Chin K, Matsushima T, Takahari D, et al. Retrospective comparison of S-1 plus cisplatin versus S-1 monotherapy for the treatment of advanced gastric cancer patients with positive peritoneal cytology but without gross peritoneal metastasis. Int J Clin Oncol. 2017; 22:1060–1068CrossRefGoogle Scholar
- 15.Boku N, Yamamoto S, Fukuda H, et al, for the Gastrointestinal Oncology Study Group of the Japan Clinical Oncology Group. Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol. 2009; 10: 1063–9.CrossRefGoogle Scholar
- 20.Iwasaki Y, Terashima M, Mizusawa J, et al. Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer: Japan Clinical Oncology Group study (JCOG0501). 2018 ASCO annual meeting. J Clin Oncol. 2018; 36 Suppl: abstract no. 4046.Google Scholar
- 23.Tsuburaya A, Yoshida K, Kobayashi M, et al. Sequential paclitaxel followed by tegafur and uracil (UFT) or S-1 versus UFT or S-1 monotherapy as adjuvant chemotherapy for T4a/b gastric cancer (SAMIT): a phase 3 factorial randomised controlled trial. Lancet Oncol. 2014;15(8):886–93CrossRefGoogle Scholar
- 26.Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010; 376:687–97CrossRefGoogle Scholar
- 28.Manzanedo I, Pereira F, Rihuete Caro, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer with peritoneal carcinomatosis: multicenter study of spanish group of peritoneal oncologic surgery (GECOP). Ann Surg Oncol. 2019;26(8):2615–21.Google Scholar