Clinical implication of peritoneal cytology in the pancreatic cancer patients who underwent curative resection followed by adjuvant gemcitabine or s-1 chemotherapy.

Abstract

252 Background: The clinical implications of peritoneal lavage cytology (CY) status in the patients who received curative resection and adjuvant chemotherapy have not been established. The clinical implications of peritoneal lavage cytology (CY) status in the patients who received curative resection and adjuvant chemotherapy have not been established. Methods: We retrospectively analyzed clinical data from 143 consecutive patients who underwent macroscopically curative resection and received adjuvant gemcitabine or S-1 chemotherapy for pancreatic cancer from 2005 to 2014 in our institution. Correlations between CY status and survival and clinicopathological features were investigated. Results: Of the 143 patients, 21 patients were peritoneal washing cytology positive (CY+) (14.7%). Although significant difference was observed in the tumor size, no other correlation between cytology status and clinicopathological parameter existed (age, gender, histology, UICC T status, LN metastasis, lymphovascular invasion). The recurrence free survival (RFS) rates at 3 and 5 years after surgery were 5.1% and 0% in CY+ patients, respectively, and were 21.5% and 16.1% in peritoneal washing cytology negative (CY-) patients, respectively, which were significantly different (p<0.001). On the other hands, the OS rates at 3 and 5 years after surgery were 17.1% and 8.6% in CY+ patients, respectively, and were 26.1% and 16.1% in CY- patients, respectively, which were trend to worse in the CY+ patients. However, there was not significantly different (p=0.254). Conclusions: The patients with CY+ are likely to experience recurrence, even after they received curative resection and adjuvant Gemcitabine or S-1adjuvant chemotherapy. To improve the patient’s survival, it is necessary to develop efficient treatment for CY+ patients.

Prognostic value of occult tumor cells obtained by peritoneal lavage in patients with resectable pancreatic cancer and no ascites: A systematic review

“…Two studies did not perform a statistical analysis on OS and therefore no conclusions could be drawn, but one study possibly shows a possible trend towards a better OS in patients without OPTC (24 months in CY− patients vs. 15 months in CY+ patients) . In the other study the OS was 15 months in CY− patients versus 16 months in CY+ patients .…”

“…Risk factor analysis demonstrated positive cytology to be an independent risk factor for a worse OS (Table ) . Other risk factors for a worse OS were lymphatic invasion , large tumor size , lymh node metastases, distant metastases, advanced stage (IIB or III), advanced tumor histological grade (G3) , portal vein invasion , invasion of the retroperitoneal tissue , vascular invasion , bile duct invasion , plexus invasion , positive resection margin , and recurrence site (worse OS in peritoneal recurrence vs. extraperitoneal recurrence) .…”

“…One study did not perform a statistical analysis on RFS, but possibly shows a trend towards a better RFS in patients without OPTC (12 months in CY− patients vs. 8 months in CY+ patients) .…”

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

“…Some surgeons from Japan believed that CY+ status in the absence of other distant metastasis was not a contraindication for radical surgery and that surgical resection offered a chance for long-term survival [15, 16, 20, 25]. In contrast, other studies suggested that patients with CY+ experienced peritoneal recurrence and poor survival time inspite of radical surgery and adjuvant chemotherapy [11–14]. In a recent large-scale multicenter study with 984 cases receiving R0 resection, Satoi and colleagues reported that OS of CY+ patients (median survival time: 16 months; 3 year OS rate: 6 %) was worse than CY− patients (median survival time: 25 months; 3-year OS rate: 37 %; p < 0.001).…”

“…Some studies from Japan reported that CY+ without distant metastasis should not preclude resection in resectable pancreatic cancer patients and that long-term survival was possible after adjuvant chemotherapy [15, 16, 20]. In contrast, several other studies showed that patients with CY+ status were associated with advanced disease and poor prognosis and had survival rates equivalent to other stage IV diseases [11–14]. Due to these inconsistent conclusions, the American Joint Committee on Cancer and treatment guideline from the National Comprehensive Cancer Network considered CY+ as stage IV metastasis and contraindicator for pancreatic resection [21, 22].…”