Factors predicting peritoneal recurrence in advanced gastric cancer: implication for adjuvant intraperitoneal chemotherapy

Abstract

Background Despite adjuvant chemotherapy, patients with advanced gastric cancer (AGC) often develop recurrence, and the peritoneum is the most common site of recurrence. Therefore, intraperitoneal chemotherapy (IPC) has been proposed as a treatment option. The aim of this study was to select the eligible patients for application of IPC. The first site of recurrence was the peritoneum in 144 patients (58.8 %), and the 5-year peritoneal recurrence-free survival was 79.3 %. Depth of tumor invasion CT3, extensive lymph node metastasis (N3), Bormann type 4, infiltrative type (Ming's classification), and venous invasion were independent risk factors for peritoneal recurrence. In subgroup analysis with patients who had received adjuvant chemotherapy (n = 481), depth of tumor invasion CT3, Bormann type 4, infiltrative type (Ming's classification), and venous invasion were independent risk factors for peritoneal recurrence. When a peritoneal recurrence risk index was made with each risk factor assigned 1 point (2 points for T4 stage), peritoneal recurrence rates with 0, 1, 2, 3, 4, or 5 points were 0 %, 3.9 %, 13.1 %, 33.3 %, 44.0 %, and 72.0 %, respectively, in those patients. Conclusions Patients at higher risk for peritoneal recurrence can be identified from the findings of this study. Further prospective studies are required to evaluate the usefulness of IPC for these patients.

Recursive partition analysis of peritoneal and systemic recurrence in patients with gastric cancer who underwent D2 gastrectomy: Implications for neoadjuvant therapy consideration

“…Peritoneal recurrence was the most predominant failure pattern after D2 gastrectomy with adjuvant chemotherapy. These findings were congruent with those from previous studies, which indicated that adjuvant chemotherapy was effective but not sufficient to prevent peritoneal recurrence [16][17][18]. Because peritoneal recurrence has a detrimental effect on not only survival but also on quality of life, there is a growing interest in the development of novel adjuvant treatments for patients at high-risk for peritoneal recurrence [19].…”

“…In the present study, an upper body tumor, the presence of perineural invasion, diffuse type histology, T4, and advanced N stage (N2, N3a, and N3b) were all significant independent risk factors for peritoneal recurrence. These findings are congruent with those from previous studies [16,17]. However, by performing RPA on the above-mentioned factors, patients at risk of peritoneal recurrence could be grouped into two classes: high-risk (T4) and low-risk (T1-3).…”

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

“…Although previous studies showed no difference in prognosis between peritoneal recurrence and distant metastasis (8,25,26), the evaluation of risk factors for peritoneal recurrence and distant metastasis could improve selection of treatment and follow-up strategies. Depth of tumor invasion, lymph node metastasis, tumor size, Lauren classification diffuse type, undifferentiated cancer, and Bormann classification type 4 are independent risk factors for peritoneal recurrence (5,7,8,25,27,28). Meanwhile, depth of tumor invasion, lymph node metastasis, venous invasion, and Lauren classification intestinal type were determined to be independent risk factors for distant metastasis (5,8,25,28).…”

“…Risk factors for peritoneal metastasis such as depth of tumor invasion and lymph node metastasis are related to high 18 F-FDG uptake (13,16,29). In contrast, tumors with diffuse type of Lauren classification and Bormann classification type 4 that show low 18 F-FDG uptake are also risk factors for peritoneal recurrence (5,7,9,13,21,28,31). Further, the high peritoneal recurrence rate in signet-ring cell carcinoma/ mucinous adenocarcinoma, which is known to have low 18 F-FDG uptake, could have contributed to the results of this study (9,13,21).…”

“…Although early detection of cancer recurrence is important for improving prognosis, detection is difficult in some of the AGC patients because of varying recurrence patterns such as locoregional recurrence, peritoneal recurrence, and distant metastasis. Moreover, adjuvant treatment such as intraperitoneal chemotherapy focuses on specific sites of potential recurrence (7,8). Hence, understanding the relationship between clinicohistopathologic factors and patterns of cancer recurrence could help in planning adjuvant treatment and selecting diagnostic studies during the follow-up (5,8).…”