Intraoperative peritoneal lavage cytology offers prognostic significance for gastric cancer patients with curative resection

Abstract

Outcomes of patients with gastric cancer who exhibit positive peritoneal lavage cytology findings (CY +) vary by diagnostic methods because of quantitative and qualitative cancer cell diversity. This study sought to establish practical diagnostic criteria for performing curative resections, based on peritoneal lavage cytology findings in gastric cancer patients. We enrolled 1028 patients with gastric cancer who underwent R0/1 (n = 911) or R2 (n = 117) resections and analyzed relationships between cancer cell findings in peritoneal lavage fluid and clinicopathological factors in the R0/1 group. We found 68 patients with CY + status. Receiver operating characteristic analyses and multivariate analyses showed that the presence of ≥1 signet ring cell, ≥5 cell clusters or ≥50 isolated cancer cells in peritoneal lavage fluid predicted poor prognoses in the 68 CY + patients. High‐risk CY + group patients with at least one of the above predictors had the highest hazard ratio (HR = 3.28, P < 0.001). The remaining (low‐risk) patients had a survival curve similar to that of patients with a normal cytology. The high‐risk CY + patients who underwent R1 resection had poor prognoses despite no macroscopic peritoneal metastasis (2% 5‐year survival)—equivalent to that of patients who underwent R2 resection. The CY + criteria defined in this study could help identify candidates for curative resection as an initial therapy for gastric cancer.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Gastric Cancer Patients with Peritoneal Metastasis (PM): Results of a Single-Center Experience and Register Study

“…Final results of these studies are not available yet. Patients with “high-risk cytology” and evidence of at least one of the mentioned predictors had a significantly worse survival chance than “low-risk patients” [27]. These new cytologic criteria could possibly contribute to the identification of patients who might benefit from the addition of PIPAC to the current standard of care therapy.…”

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

“…Die Ergebnisse von Patienten mit Magenkarzinom und positiver Zytologie in der Peritoneallavage unterscheiden sich derzeit durch diagnostische Methoden aufgrund der quantitativen und qualitativen Diversität der Tumorzellen. Neuere Untersuchungen konnten zeigen, dass der Nachweis von ≥ 1 Siegelringzellen, ≥ 5 Zellverbänden und ≥ 50 isolierten Tumorzellen in der Peritoneallavage-Flüssigkeit eine schlechte Prognose bei positiver Zytologie bedeutet [368].…”

“…Patienten mit "High-Risk-Zytologie" und Nachweis mindestens eines der o. g. Prädiktoren hatten in der Analyse von Higaki et al eine signifikant schlechtere Prognose als "Low-Risk-Patienten", deren Überlebenskurve ähnlich derjenigen von Patienten mit normaler Zytologie war [368]. Die neuen zytologischen Kriterien könnten zukünftig dazu beitragen, Patienten zu identifizieren, die von zusätzlichen Therapiemaßnahmen profitieren, wie z.…”

Laparoscopía de etapificacíon y citología peritoneal en cáncer gástrico. Descripción de la técnica y revisión de la literatura

“…En los estudios aparecen diferentes formas de practicar la laparoscopia de estadificación en cuanto a: los cuadrantes, si revisar o no la transcavidad de los epiplones, en relación a los mililitros a utilizar [5][6][7][8][9][10] . Los criterios para indicar esta laparoscopía varían entre los distintos centros, por lo que sus resultados como prueba diagnóstica es variable entre los distintos estudios [5][6][7] .…”