Factors associated with peritoneal metastasis in non-serosa-invasive gastric cancer: a retrospective study of a prospectively-collected database

Abstract

BackgroundPeritoneal dissemination is the most common type of recurrence in advanced gastric cancer. The main mechanism is thought to be via the exfoliation of free cancer cells (FCCs) from tumor in the gastric serosa. The frequency of recurrence thus increases once the tumor cells penetrate the serosa. However, this type of recurrence also occurs in patients without serosal invasion, though the mechanisms responsible for have not been fully established. We therefore investigated the factors associated with peritoneal dissemination in patients with non-serosa-invasive gastric cancer.MethodsA total of 685 patients with non-serosa-invasive gastric cancer who underwent curative resection with retrieval of more than 15 nodes were selected. The associations between clinicopathological features and peritoneal dissemination were analyzed. Among them, the tumor infiltrating growth pattern (INF) were classified into α, β and γ according to the Japanese Classification of Gastric Carcinoma (JCGC).ResultsThe overall incidence of peritoneal metastasis was 20% (137/685). Age, Borrmann type, differentiation, INF, nodal status and free cancer cells (FCCs) were correlated with peritoneal dissemination using univariate analysis. However, only INF, Borrmann type and TNM node stage were identified as independent correlated factors with peritoneal metastasis by multivariate analysis when FCCs were excluded, and these were also prognostic factors. Peritoneal dissemination was more common in patients with INFγ, Borrmann III/IV and N3 stage. Among patients without FCCs, nodal involvement or vessel invasion, only INF remained an independent associated factor according to multivariate analysis.ConclusionsTumor infiltrating growth pattern (INF), together with Borrmann type and TNM node stage, are important factors associated with peritoneal metastasis in non-serosa-invasive gastric cancer.

Prognostic significance of tumour infiltration growth pattern in patients with advanced gastric cancer

“…Similarly, Song et al found that T3 stage patients with INFc pattern had more frequent peritoneal recurrence than those with INFa/b pattern 14. In the previous research, we also had reported that INFc pattern was independently associated with peritoneal metastasis in patients with GC without serosal invasion 17. Although the inconsistent results still exist in several studies, we believed that the prognostic significance of INF pattern in patients with advanced GC should not be ignored.…”

“…The detailed pathological features of three INF patterns were shown as we reported previously (figure 1). 17 INFa was described as the tumour lesion that showed a expanding growth and a distinct border with the surrounding tissue. INFc was described as the tumour lesion that exhibited a infiltrating growth and a indistinct border with the surrounding tissue.…”

Whole-exome sequencing to identify somatic mutations in peritoneal metastatic gastric adenocarcinoma: A preliminary study

“…Approximately 40% of gastric cancer cases occur in China, and many are diagnosed at an advanced stage with a tendency toward metastasis and recurrence [4]. Peritoneal carcinoma occurs in both the advanced and early stages of gastric cancer and is the most common type of metastasis and recurrence [5–7]. The median survival of patients with peritoneal metastasis is less than 6 months due to the development of resistance to therapy [8–11].…”

Relationship Between 18F-FDG Uptake on PET and Recurrence Patterns After Curative Surgical Resection in Patients with Advanced Gastric Cancer

“…In our study, enrolled patients had a median clinical follow-up of 51.7 mo, which was considerably longer than previous studies (13,15,20). Our study showed that 18 F-FDG uptake of gastric cancer remained an independent prognostic factor for recurrence-free survival and overall survival in AGC patients, along with pT stage, lymph node metastasis, and lymphovascular invasion, which were already known to be significant prognostic factors (5,(22)(23)(24). Different from these prognostic factors, 18 F-FDG PET is advantageous in providing prognostic information even before surgery.…”