Laparoscopic-Assisted Intraperitoneal Chemotherapy for Patients with Scirrhous Gastric Cancer

Abstract

Background: The prognosis for patients with scirrhous gastric cancer (SGC) is extremely poor. To improve the patients’ prognosis, laparoscopic-assisted intraperitoneal chemotherapy (IPC) was introduced for SGC. In this study, we analyzed whether IPC reduced the number of cancer cells in the peritoneal cavity of patients or changed the gene expression levels of cytokines in the peritoneal cavity. We also investigated whether IPC improved the prognosis of patients with SGC. Methods: Total RNA was extracted from 50 ml of peritoneal wash from 11 SGC patients before and after cisplatin-based IPC. The gene expression levels of survivin, c-myc, transforming growth factor-β (TGF-β), interleukin-2 (IL-2), IL-6, and IL-12 were analyzed using real-time reverse transcription-polymerase chain reaction (RT-PCR) assays. Also, carcinoembrionic antigen (CEA) messenger RNA (mRNA) was used to identify the number of gastric cancer cells in peritoneal washes by the real-time RT-PCR method. The gene expression levels of cytokines and the number of cancer cells in the peritoneal cavity were compared before and after cisplatin-based IPC treatment. Results: Before IPC, the gene expression of IL-2 from peritoneal washes of patients was significantly suppressed compared to the controls (p = 0.029); however, other gene expression levels did not differ. In 7 cases, more than 90% of the cancer cells were removed from the peritoneal cavity after cisplatin-based IPC. These 7 cases were named the IPC effective group, and the remaining 4 cases were named the IPC ineffective group. In the IPC effective group, elevated IL-2 and IL-6 genes were detected in 5 (71%) and in 6 (86%) after IPC. The correlation between IPC effectiveness and elevated gene expression after IPC (IL-2: p = 0.137, and IL-6: p = 0.044) was observed. However, the 50% survival period of the IPC effective group (9 months) was not different from that of that of the IPC ineffective group (6 months, p = 0.267). Conclusion: IPC effectiveness may correlate with elevation of gene expression of inflammatory cytokines, such as IL-2 and IL-6 in the peritoneal cavity after IPC. However, the prognostic benefits of IPC for SGC patients remain unclear.

Biological significance of localized Type IV scirrhous gastric cancer

“…LSGC, localized type IV scirrhous gastric cancer; LP, linitis plastica; OGC, other types of advanced gastric cancer. and strong chemotherapy, including S-1, may be a more favorable option than aggressive surgery or palliative gastrectomy (2,3,13,16). In the present study, peritoneal cytology was an independent prognostic factor in SGC.…”

“…SGC has been shown to possess unique clinicopathological characteristics and a poor survival outcome despite curative gastrectomy (10)(11)(12)(13)(14)(15)(16)(20)(21)(22)(23). One reason for the poor prognosis specific to SGC is the difficulty in early detection.…”

“…By contrast, numerous studies have commented on the definition (1-4), incidence (10), significance (11), pathology (12), prognosis (10)(11)(12) and management strategy (13)(14)(15)(16) of SGC pertaining solely to the early and the final phase of the disease.…”

Efficacy of S-1 for Patients with Peritoneal Metastasis of Gastric Cancer

“…Peritoneal metastasis is a predominant metastatic pattern in advanced gastric cancer [1,2] , and the prognosis of patients with peritoneal metastasis of gastric cancer is poor [3] . The median survival time (MST) of such patients is reported to be 3-6 months [4] , and a standard regimen against peritoneal metastasis of gastric cancer has not yet been established.…”

Establishment of the Standard Prophylactic Strategy for Peritoneal Recurrence and Proposal of the Optimal Therapeutic Protocol for Gastric Cancer

“…Accordingly, the treatment recommendations for gastric cancer in the event of positive cytology range from palliative chemotherapy to attempts at neo-adjuvant therapies followed by surgical resection. However, the results of published randomized clinical trials of adjuvant perioperative intra-peritoneal chemotherapy have not fully demonstrated any significant improvement in survival as compared with surgery alone, especially in the cases with P+ (Cunliffe & Sugarbaker, 1989;Cheong et al, 2007;Hagiwara et al, 1992;Ikeguchi et al, 2005;Kunisaki et al, 2002;Sauter et al, 1994). Therefore, a reliable and appropriate standard prophylactic regimen for peritoneal recurrence in patients with gastric cancer needs be established.…”