Clinical significance of initial treatment for peritoneal lavage cytology-positive gastric cancer: outcomes according to treatment strategy

Abstract

Background Although patients with positive lavage cytology (CY1) are classified as having stage IV disease, long-term survival without other unresectable factors (P0CY1) has been reported. Conversion gastrectomy in patients with a change in cytology status after induction chemotherapy might improve survival, but appropriate treatment remains controversial. Here, we reviewed our experience in treating CY1 gastric cancer to evaluate the best treatment strategy. Methods Clinical and pathological findings of patients with a diagnosis of P0CY1 gastric cancer at Toranomon Hospital between February 2006 and April 2019 were retrospectively analyzed. Patients were classified into two groups according to initial treatment: a surgery-first group and a chemotherapy-first group. In addition, the patients were categorized into subgroups based on the subsequent treatment pattern. The surgery-first group was divided into two subgroups: adjuvant chemotherapy and palliative gastrectomy only. The chemotherapy-first group was divided into three subgroups with the subsequent treatment pattern depending on the response to chemotherapy: conversion gastrectomy, palliative gastrectomy after induction therapy, and palliative chemotherapy. Results In total, 38 patients were eligible for inclusion in this study. After initial assessment of cytology status, 21 patients underwent gastrectomy as initial treatment (surgery first) and 17 received induction chemotherapy (chemotherapy first). Ten patients underwent surgery first with adjuvant chemotherapy, 11 underwent palliative gastrectomy alone, 5 underwent conversion surgery, 5 with CY1 disease after induction chemotherapy underwent palliative gastrectomy, and 7 received palliative chemotherapy only. The 3-year survival rate was 23.4% (median survival, 17.7 months) in the surgery-first group and 27.3% (median survival, 19.7 months) in the chemotherapy-first group. The 3-year survival rate was 75% for conversion gastrectomy, 16.7% for palliative chemotherapy, and 0% for palliative gastrectomy after induction chemotherapy. Conclusions There was no significant difference in outcome according to whether surgery or chemotherapy was performed first. The prognosis of conversion surgery with curative resection was better than that of the other types of treatment. However, the outlook after induction chemotherapy was poor. Patients with advanced gastric cancer should be treated cautiously until more effective treatment options become available.

Efficacy of chemotherapy versus surgery as initial treatment for gastric cancer with positive peritoneal cytology

“…Notably, in subgroup analysis of chemotherapy-initial group, OS and PFS did not differ significantly between patients who converted to CY0 and received radical surgery and patients who with persistent CY1 after chemotherapy and received palliative surgery. This result was not consistent with the previous studies reported by Lorenzen and Yago [ 18 , 22 ]. However, it should be noted that the patients who received palliative surgery in abovementioned studies did not receive adjuvant chemotherapy as routine.…”

“…Nevertheless, there was no statistically significant difference between two groups in OS and PFS in our study. This result was consistent with part of previous studies [ 22 , 23 ]. In a multi-institutional retrospective study from Japan, the survival outcomes were comparable in initial-Cx and initial-Sx groups for GC patients with CY1 or/and P1a, with median OS of 24.8 months and 24.0 months, respectively [ 24 ].…”

Macroscopic type is implicated in the prognostic impact of initial chemotherapy on peritoneal lavage cytology-positive gastric cancer with no other noncurative factors

“…In this study, type 4 CY1 GC had signi cantly lower OS rate than non-type 4 CY1 GC, which was similar to previous studies [27,28]. The proportion of patients with type 4 CY1 GC and no other noncurative factors was reported to be 25.0-43.1%, which was higher than that in the entire cohort of patients with advanced GC (6.8-13.2%) [17][18][19][27][28][29][30][31]. Among the enrolled patients, 25 [11,14].…”

Efficacy of Staging Laparoscopy in Patients With Pancreatic Cancer: A Single Center Prospective Cohort Study

“…Although full inspection of peritoneal cavity could not be achieved in three (9%) patients, peritoneal lavage could be performed in all patients. Peritoneal cytology (CY) has been used widely in the diagnosis and staging of various cancers, such as ovarian, and gastric cancer (15)(16)(17). Positive peritoneal cytology (CY+) in patients with PC is equivalent to metastatic disease and Stage IV according to the American Joint Committee on Cancer and the NCCN (18,19).…”