A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

Abstract

Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most appropriate treatment regimen for this particular patient group. We reviewed and analyzed published data to determine the optimal treatment regimen for patients with peritoneal cytology-positive gastric adenocarcinomas. Six electronic databases were explored [PubMed, Cochrane (Systematic Reviews and Controlled Trials), PROSPERO, DARE, and EMBASE]. The primary outcome was overall survival with secondary outcomes including patterns of recurrence and treatment-related morbidity. Six studies were included for data extraction. There was no significant heterogeneity between studies. The use of S1 monotherapy was associated with a significant survival benefit (HR 0.48; 95 % CI 0.32-0.70; p = 0.0002). Intraoperative intraperitoneal chemotherapy (IIPC) with adjuvant chemotherapy showed a trend toward improvement in overall survival (HR 0.70; 95 % CI 0.47-1.04; p = 0.08). A recent randomized controlled trial examining extensive intraperitoneal lavage (EIPL) with IIPC showed a significant improvement in overall survival (5-year overall survival, 43.8 % for EIPL-IPC group compared with 4.6 % for IPC group). However, these promising results need to be validated in larger prospective randomized trials.

Regional but fatal: Intraperitoneal metastasis in gastric cancer

“…The oral anticancer drug S1 is a fluoropyrimidine derivative, combining tegafur with two modulators. A recent meta-analysis showed that the use of S1 monotherapy was associated with a significant survival benefit (HR = 0.48, 95%CI: 0.32-0.70, P = 0.0002)[41]. The advantage of S1 over other chemotherapeutic agents is its ability to attain higher concentrations intraperitoneally, due to the higher concentrations of 5-FU and CDHP achieved in peritoneal tumors than in plasma[42,43].…”

Prognostic significance of positive peritoneal cytology in resectable pancreatic cancer: a systemic review and meta-analysis

“…In the gastric, colon and gynecological malignancies, microscopic occult peritoneal metastases preceded the emergence of macroscopic metastases and such patients were precluded from radical surgery [8, 28–30]. However, the impact of CY+ on long-term survival of pancreatic cancer was uncertain.…”

Re‐emerging role of macroscopic appearance in treatment strategy for gastric cancer

“…In terms of cytology‐positive gastric cancers, we showed that absence of peritoneal dissemination can predict long‐term survival of patients with advanced gastric cancer with a positive cytology test and long‐term postoperative adjuvant therapy with S‐1 was required for survival of patients with CY1 in the absence of peritoneal dissemination over 5 years . A recent systematic review also showed that the use of S‐1 monotherapy was associated with a significant survival benefit in CY1 patients (HR 0.48; 95% CI 0.32‐0.70; P = 0.0002) . Although randomized controlled trials are needed, S‐1 monotherapy, due to its easy feasibility, may be very promising for gastric cancer with the unresectable factor of cytology positive alone, and this theoretical rationale is applicable to Type III/IV gastric cancer.…”