Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer

Bonenkamp, Johannes J.; Songun, Ilfet; Hermans, J.; Velde, Cornelis J.H. van de

doi:10.1002/bjs.1800830526

Cited by 216 publications

(170 citation statements)

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“…Several authors have performed cytology at the time of attempted (R0) resection and found detection rates to range from 3·9 per cent 10 to 21·4 per cent 14 . The rate in the present series (7·2 per cent) is similar to that found in several other studies 12,32,33 , even though most other studies have been confined to gastric cancer. The variation may also be accounted for partly by the use of immunocytochemistry in some studies.…”

Section: Discussionsupporting

confidence: 91%

Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma

Nath

Moorthy

Tanière

et al. 2008

British Journal of Surgery

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Background: The aim of the study was to determine the value of performing peritoneal lavage cytology during laparoscopy in the management of oesophagogastric adenocarcinoma.Methods: Laparoscopy combined with peritoneal cytology was performed in patients with potentially resectable oesophagogastric adenocarcinoma. Macroscopic peritoneal findings at laparoscopy and the presence of free peritoneal tumour cells were recorded. All patients were followed to death or the census point. Patients with overt peritoneal disease or positive cytology were offered palliative chemotherapy, subject to performance status.Results: Forty-eight (18·8 per cent) of 255 patients had overt peritoneal metastases at staging laparoscopy. Fifteen (7·2 per cent) of the remaining 207 patients had positive cytology; these patients had a median (95 per cent confidence interval) survival of 13 (3·1 to 22·9) months, versus 9 (7·4 to 10·6) months for those with overt peritoneal metastases (P = 0·517). Of patients receiving chemotherapy, those without overt metastases had a slight survival advantage over patients with metastases (median 15 (10·8 to 19·2) versus 9 (7·4 to 10·7) months; P = 0·045). Conclusion:Positive peritoneal cytology in the absence of overt peritoneal metastases is not uncommon in oesophagogastric adenocarcinoma. It is a marker of poor prognosis even in the absence of overt peritoneal metastases.

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Section: Discussionsupporting

confidence: 91%

Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma

Nath

Moorthy

Tanière

et al. 2008

British Journal of Surgery

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“…While many patients who present with perforation are diagnosed with stage IV or non-curable disease, a significant number of patients with stage I-III disease may benefit from curative-intent resection. Spillage of tumor into the peritoneal cavity as a result of perforation was thought to carry a poor prognosis, similar to that of peritoneal disease [14,15]; however, several of the publications in this review argue that peritoneal contamination did not adversely affect survival in these patients [4,9,11].…”

Section: Discussionmentioning

confidence: 83%

Surgical management of gastric perforation in the setting of gastric cancer

et al. 2011

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Background Gastric perforation is a rare presentation of gastric cancer and is thought to be a predictor of advanced disease and, thus, poor prognosis. Guidelines do not exist for the optimal management strategy. We aimed to identify, review, and summarize the literature pertaining to perforation in the setting of gastric cancer. Methods A qualitative, systematic review of the literature was performed from January 1, 1985, to January 1, 2010. Searches of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were performed using search terms related to gastric cancer surgery. Abstracts were examined by two independent reviewers and a standardized data collection tool was used to extract relevant data points. Summary tables were created.Results Nine articles were included. Perforation was reported to occur in fewer than 5% of gastric cancer patients. Preoperative diagnosis of a gastric cancer was rated and occurred in 14-57% of patients in the papers reviewed. Mortality rates for emergency gastrectomy ranged from 0 to 50% and for simple closure procedures the rates ranged from 8 to 100%. Patients able to receive an R0 gastrectomy demonstrated better long-term survival (median 75 months, 50% 5-year) compared with patients who had simple closure procedures. Conclusions Gastric cancer patients presenting with a gastric perforation demonstrate improved overall survival with an R0 resection; however, implementation of this management technique is complicated by infrequent preoperative gastric cancer diagnosis, and inability to perform an oncologic resection due to patient instability and intraabdominal contamination.

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“…Palliative resections offer no survival advantage and are associated with higher operative mortality rates compared with curative resections (Allum et al, 1989;Akoh et al, 1991; Wanebo et al, 1993). Laparoscopy and cytological examination of abdominal washings increase the accuracy of preoperative staging, but are not used routinely (Bonenkamp et al, 1996). Therefore, there is a need for additional, reliable prognostic factors by which tumour aggressiveness can be determined, and the presence of lymph node metastasis and resectability for cure can be predicted, preferably by analysis of biopsy specimens.…”

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confidence: 99%

Expression of oncoproteins and the amount of eosinophilic and lymphocytic infiltrates can be used as prognostic factors in gastric cancer

Songun

Velde²,

Hermans³

et al. 1996

Br J Cancer

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Summary Preoperative staging of gastric cancer is difficult. Several molecular markers associated with initiation and progression of cancer seem promising for obtaining preoperative prognostic information. To investigate whether these markers are indicative especially for the presence of lymph node metastases in patients with gastric cancer, we have examined primary tumour specimens from 105 patients with primary adenocarcinoma of the stomach entered in a surgical trial. In this trial, lymph node status was determined by strictly quality-controlled lymph node dissection and examination. The selected markers were growth regulators (p53, Rb and myc), metastasis-suppressor gene product (nm23), adhesion molecules (Ep-CAM, E-cadherin, CD44v5 and CD44v6) and urokinase-type plasminogen activator (u-PA). Also, the amount of eosinophilic and lymphocytic infiltrates available post-operatively was analysed with respect to its prognostic value for lymph node status. Moreover, the association of these parameters with survival and disease-free period (DFP) was evaluated. Of all molecular markers investigated, only Rb expression had a significant association with the presence of lymph node metastasis in both univariate and multivariate analysis. For curative resectability, a significant association was found with Rb and E-cadherin expression, while in multivariate analysis Rb and myc were selected as the combination with additional independent prognostic value, and E-cadherin had no additional independent value. For overall survival in univariate analysis, the amount of both eosinophilic and lymphocytic infiltrates and Rb and myc expression were of significant prognostic value. Only the amount of lymphocytic infiltrate had a prognostic significance for DFP. In stepwise multivariate analysis, TNM stage (I+II) and marked lymphocytic infiltrate were associated with better overall survival and longer DFP. We conclude that, if these results are confirmed in a larger series of patients, molecular markers can provide useful prognostic information.Keywords: gastric cancer; metastasis; prognosis; molecular marker Despite declining incidence, gastric cancer remains a major clinical management problem with poor prognosis: overall 5 year survival rates vary between 5% and 11%. Only a curative resection (complete tumour removal) offers hope of a cure, but the majority of the patients are diagnosed at an advanced disease stage (Allum et al., 1989). At diagnosis, the first decision to be made is whether or not to attempt a curative resection. This decision is based on stage of disease, which is assessed by radiograph of the stomach, chest and ultrasound of the liver or computerised tomography (CT) scan of the abdomen. Palliative resections offer no survival advantage and are associated with higher operative mortality rates compared with curative resections (Allum et al., 1989;Akoh et al., 1991; Wanebo et al., 1993). Laparoscopy and cytological examination of abdominal washings increase the accuracy of preoperative staging, but are not used r...

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Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer

Cited by 216 publications

References 4 publications

Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma

Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma

Surgical management of gastric perforation in the setting of gastric cancer

Expression of oncoproteins and the amount of eosinophilic and lymphocytic infiltrates can be used as prognostic factors in gastric cancer

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