Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2017; 9(3): 121-128
Published online Mar 15, 2017. doi: 10.4251/wjgo.v9.i3.121
Gastric peritoneal carcinomatosis - a retrospective review
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Su Pin Choo, David Wai-Meng Tai, Clarinda Wei Ling Chua, Matthew Chau Hsien Ng, Khee Chee Soo, Melissa Ching Ching Teo
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
Su Pin Choo, David Wai-Meng Tai, Clarinda Wei Ling Chua, Matthew Chau Hsien Ng, Dvision of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
Author contributions: Tan HL conceptualized the study, collected the data, analyzed the data and wrote the manuscript; Chia CS, Tan GHC and Teo MCC conceptualized the study and critically revised the manuscript; Choo SP, Tai DWM, Chua CWL and Ng MCH assisted in data collection and critically revised the manuscript; Soo KC critically revised the manuscript.
Institutional review board statement: This study involved an electronic medical record review of the included human study subjects. Ethics approval was obtained from the Singhealth Centralised Institutional Review Board.
Informed consent statement: No informed consent was deemed necessary as majority of the patients we studied have passed away at the point of the study. Furthermore, the study involved a retrospective electronic medical record review, with no patient identifiers included in the results presented, hence bearing minimal risk to the patients included in the study.
Conflict-of-interest statement: There are no conflict-of-interests to declare for any of the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Melissa Ching Ching Teo, Senior Consultant/Head, MBBS, MMed (Surg), FRCSEd, FAMS, MPH, Adjunct Associate Professor, Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore. melissa.teo.c.c@singhealth.com.sg
Telephone: +65-4368088 Fax: +65-62256283
Received: November 1, 2016
Peer-review started: November 4, 2016
First decision: November 30, 2016
Revised: December 13, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: March 15, 2017
Abstract
AIM

To characterize patients with gastric peritoneal carcinomatosis (PC) and their typical clinical and treatment course with palliative systemic chemotherapy as the current standard of care.

METHODS

We performed a retrospective electronic chart review of all patients with gastric adenocarcinoma with PC diagnosed at initial metastatic presentation between January 2010 and December 2014 in a single tertiary referral centre.

RESULTS

We studied a total of 271 patients with a median age of 63.8 years and median follow-up duration of 5.1 mo. The majority (n = 217, 80.1%) had the peritoneum as the only site of metastasis at initial presentation. Palliative systemic chemotherapy was eventually planned for 175 (64.6%) of our patients at initial presentation, of which 171 were initiated on it. Choice of first-line regime was in accordance with the National Comprehensive Cancer Network Guidelines for Gastric Cancer Treatment. These patients underwent a median of one line of chemotherapy, completing a median of six cycles in total. Chemotherapy disruption due to unplanned hospitalizations occurred in 114 (66.7%), while cessation of chemotherapy occurred in 157 (91.8%), with 42 cessations primarily attributable to PC-related complications. Patients who had initiation of systemic chemotherapy had a significantly better median overall survival than those who did not (10.9 mo vs 1.6 mo, P < 0.001). Of patients who had initiation of systemic chemotherapy, those who experienced any disruptions to chemotherapy due to unplanned hospitalizations had a significantly worse median overall survival compared to those who did not (8.7 mo vs 14.6 mo, P < 0.001).

CONCLUSION

Gastric PC carries a grim prognosis with a clinical course fraught with disease-related complications which may attenuate any survival benefit which palliative systemic chemotherapy may have to offer. As such, investigational use of regional therapies is warranted and required validation in patients with isolated PC to maximize their survival outcomes in the long run.

Keywords: Peritoneal carcinomatosis, Gastric cancer

Core tip: We present a retrospective review of the clinical course and treatment outcomes of patients with gastric peritoneal carcinomatosis. It carries a poor prognosis with a clinical course fraught with disease-related complications which disrupts planned systemic palliative chemotherapy in the majority of patients. Such disruptions attenuate the benefits of systemic chemotherapy and decrease overall survival. Patients with isolated peritoneal disease may as such benefit from investigational loco-regional therapies pending further studies and validation.