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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

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Results

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).

Conclusions

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.

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Author information

Authors and Affiliations

  1. Cancer Chemotherapy Center and Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

    Toshifumi Yamaguchi MD, PhD & Kazuhide Higuchi MD, PhD

  2. Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan

    Toshifumi Yamaguchi MD, PhD, Atsuo Takashima MD, PhD & Narikazu Boku MD, PhD

  3. Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan

    Kengo Nagashima PhD

  4. Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Rie Makuuchi MD

  5. Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan

    Masaki Aizawa MD, PhD

  6. Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan

    Manabu Ohashi MD, PhD

  7. Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan

    Keitaro Tashiro MD, PhD

  8. Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan

    Tatsuya Yamada MD, PhD

  9. Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan

    Takahiro Kinoshita MD, PhD

  10. Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Hiroaki Hata MD, PhD

  11. Department of Surgery, Nagaoka Chuo General Hospital, Niigata, Japan

    Yasuyuki Kawachi MD, PhD

  12. Department of Surgery, Osaka Rosai Hospital, Osaka, Japan

    Ryohei Kawabata MD

  13. Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

    Toshikatsu Tsuji MD

  14. Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Jun Hihara MD, PhD

  15. Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan

    Takeshi Sakamoto MD

  16. Department of Surgery, Teikyo University Hospital, Tokyo, Japan

    Takeo Fukagawa MD, PhD

  17. Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan

    Hitoshi Katai MD, PhD

Authors
  1. Toshifumi Yamaguchi MD, PhD
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  2. Atsuo Takashima MD, PhD
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  8. Tatsuya Yamada MD, PhD
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  17. Hitoshi Katai MD, PhD
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  18. Kazuhide Higuchi MD, PhD
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  19. Narikazu Boku MD, PhD
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Corresponding author

Correspondence to Atsuo Takashima MD, PhD.

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Disclosure

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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Yamaguchi, T., Takashima, A., Nagashima, K. et al. 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. Ann Surg Oncol 27, 284–292 (2020). https://doi.org/10.1245/s10434-019-07697-x

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