Importance of positive peritoneal lavage cytology findings in the stage grouping of gastric cancer

Abstract

Although peritoneal lavage cytology is widely performed during surgery for gastric cancer and the results have been reported to be one of the accurate prognostic factors, the cancer stage is determined independent of the results of lavage cytology according to the First English Edition of Japanese Classification of Gastric Carcinoma. In this study we demonstrated the validity of lavage cytology for accurately staging gastric cancer. Between 1988 and 1996, peritoneal lavage cytology was performed in 347 patients with resectable gastric cancer. Among them, cytology was positive in 29 cases (8.4%). The survival rate of the cytology-positive patients in each stage was worse than that of all patients in the same stage. The prognosis of patients with positive cytology findings and serosa-exposed gastric cancer was significantly worse than that of negative cytology findings and serosa-exposed gastric cancer, and similar to that of negative cytology findings and serosa-infiltrating gastric cancer. Our data indicated that positive cytology findings thus indicated a poor prognosis, and the prognostic difference between positive and negative cytology findings was approximately a one-stage difference in the Japanese stage grouping. Based on our findings, the results of peritoneal lavage cytology should thus be included in the factors for staging gastric cancer.

Prognostic significance of peritoneal washing cytology in Thai patients with gastric adenocarcinoma undergoing curative D2 gastrectomy

“…Similarly, other reports found nodal involvement to be associated with a high incidence of positive cytology [2,10,25], and a statistically significant association was found between positive cytology and advanced stage cancer [1][2][3]7,10,25,26]. Although some previous reports confirmed the association found in this study between poor tumor differentiation and positive PWC [3,7], others found no such association [17,24].…”

“…Multivariable Cox regression found PWC to be one of the most significant independent predictors of survival. Positive PWC as an independent predictor of survival has been previously reported by many investigators [2,3,6,[8][9][10][11][12][13][14]24] with a mean survival time of 8.6-18.4 months [1,7,8,17,20,24,32]. However, the influence of positive PWC on the survival of patients with gastric cancer has not been consistent.…”

“…This is believed to be due to the presence of malignant cells that have already seeded at the time of operation but cannot be detected macroscopically. The usefulness of peritoneal washing cytology (PWC) to identify intraperitoneal free cancer cells, which have the potential for peritoneal dissemination, has been previously reported [6][7][8][9][10][11][12][13][14][15][16].…”

Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation

“…However, the mechanism of peritoneal dissemination has not yet been clearly defined so far. Free cancer cells exfoliated from cancer lesions have been postulated as the main cause of metastasis [5,[8][9][10] . Recent advances on the molecular mechanisms of peritoneal dissemination have elucidated some of the target molecules and the development of new multimodal therapies in an attempt to eliminate peritoneal exfoliated www.wjgnet.com free cancer cells has also improved survival [11] .…”

The detection of gastric cancer cells in intraoperative peritoneal lavage using the reverse transcription–loop-mediated isothermal amplification method

“…In this regard, cytologic examination of lavage fluid obtained at the time of surgery is a conventional method for detecting free cancer cells in peritoneal space. However, the sensitivity of this assay has been reported to be relatively low, ranging from 19% to 30% in gastric cancer invading the serosa [6][7][8][9] . As a result, some patients with negative cytology have nevertheless developed peritoneal recurrence.…”