Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis

Abstract

Intraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells -positive patients had higher rates of nodal spread (risk difference: 0.29; p<0.01), serosal invasion (risk difference: 0.43; p<0.01), recurrence (after 60 months of follow-up, risk difference: 0.44; p<0.01), and mortality (after 60 months of follow-up, risk difference: 0.34; p<0.01). Intraperitoneal free cancer cells are associated with a poor outcome in gastric cancer. This surrogate biomarker should be used to guide therapy both prior to and after surgery.

Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach

“…The exact prognostication of advanced gastric cancer patients with positive peritoneal washing cytology result is difficult due to variability in enrolled patients, peritoneal washing methods, and treatment of cancer patients in these studies. Recent systemic reviews and meta-analyses have shown that peritoneal washing cytology is useful for determining the prognosis of advanced gastric cancer patients [265266267268].…”

Brazilian Gastric Cancer Association Guidelines (Part 1): An Update on Diagnosis, Staging, Endoscopic Treatment and Follow-Up

“…Conventional peritoneal washing has low sensitivity and immunohistochemical and molecular techniques may be used to increase detection. Negativity cytology must be interpreted according to patient`s disease context and the surgeon`s impression 39 .…”

PCR‐based quantitative detection of intraperitoneal free cancer cells for predicting locoregional recurrence after rectal cancer resection

“…Quantitative detection of free cancer cells in peritoneal lavage fluid by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) for carcinoembryonic antigen (CEA) has been reported to be a reliable method for predicting metachronous peritoneal carcinomatosis and cancer-related mortality after curative resection in gastric cancer patients. [10][11][12][13][14] This method may also allow for sensitive detection of residual cancer cells in CRC patients. 15 In light of the relatively low incidence of peritoneal recurrence and high incidence of locoregional recurrence in patients with CRC, detecting free cancer cells with a highly sensitive method can be a better predictor for patients who underwent curative resection.…”

“…The usefulness of PCR‐based methods for detecting intraperitoneal free cancer cells has been demonstrated in patients with gastric cancer, mainly in terms of predicting peritoneal recurrence. Quantitative detection of free cancer cells in peritoneal lavage fluid by quantitative reverse transcription‐polymerase chain reaction (qRT‐PCR) for carcinoembryonic antigen (CEA) has been reported to be a reliable method for predicting metachronous peritoneal carcinomatosis and cancer‐related mortality after curative resection in gastric cancer patients 10–14 . This method may also allow for sensitive detection of residual cancer cells in CRC patients 15 .…”