Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2021; 13(1): 24-36
Published online Jan 15, 2021. doi: 10.4251/wjgo.v13.i1.24
Survival outcomes and prognostic indicators for gastric cancer patients with positive peritoneal wash cytology but no peritoneal metastasis after radical gastrectomy
Wen-Zhe Kang, Yu-Xin Zhong, Fu-Hai Ma, Li-Yan Xue, Jian-Ping Xiong, Shuai Ma, Yang Li, Yi-Bin Xie, Xu Quan, Yan-Tao Tian
Wen-Zhe Kang, Yu-Xin Zhong, Fu-Hai Ma, Jian-Ping Xiong, Shuai Ma, Yang Li, Yi-Bin Xie, Xu Quan, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing 100021, China
Author contributions: Tian YT and Xue LY designed the research; Kang WZ, Zhong YX, Ma FH, Xiong JP, and Ma S analyzed the data and wrote the paper; Li Y, Xie YB, and Xu Q collected the patient’s clinical data; Kang WZ and Zhong YX contributed equally to this work.
Supported by National Natural Science Foundation of China, No. 81772642
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study, and the data were anonymously analyzed.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at tyt67@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Yan-Tao Tian, MD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: September 8, 2020
Peer-review started: September 8, 2020
First decision: October 21, 2020
Revised: November 3, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 15, 2021
Abstract
BACKGROUND

Positive peritoneal wash cytology with no peritoneal metastasis (CY1P0) is a special type of distant gastric cancer metastasis, which describes a patient with positive peritoneal lavage cytology, but no definitive peritoneal metastasis, and there are no widely accepted treatment guidelines. We enrolled 48 primary CY1P0 gastric cancer patients treated by radical gastrectomy in this study. Our study illustrated the efficacy of radical gastrectomy for CY1P0 gastric cancer patients, and suggested that the pathological N factor and vascular invasion were significant independent risk factors for overall survival (OS).

AIM

To assess the survival of CY1P0 gastric cancer patient post-radical gastrectomy, and to identify factors associated with long-term prognosis.

METHODS

Our study included 48 patients with primary CY1P0 gastric cancer who had radical gastrectomies at the Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China between 2013 and 2018. R0 resection was achieved in all 48 patients. Twelve patients received neoadjuvant chemotherapy. Thirty patients received adjuvant chemotherapy and four received adjuvant chemoradiotherapy. OS statistics were available for 48 patients. Follow-up continued through March 2020. Univariate and multivariate analyses were performed using a Cox proportional hazards model to identify prognostic factors.

RESULTS

Median OS was 22.0 mo (95% confidence interval: 13.366-30.634 mo) post-surgery. Univariate analyses demonstrated that tumor site (P = 0.021), pathological N factor (P = 0.001), pathological T factor (P = 0.028), vascular invasion (P = 0.046), and the level of CA199 prior to initiating therapy (P = 0.002) were significant risk factors for OS. Multivariate analyses demonstrated that pathological N factor (P = 0.001) and vascular invasion (P = 0.031) were significant independent risk factors for OS.

CONCLUSION

This study suggested that radical gastrectomy may be efficient for CY1P0 gastric cancer patient post-radical gastrectomy and the pathological N factor and vascular invasion are significant independent risk factors for OS.

Keywords: Gastric cancer, Overall survival, R0 resection, Prognostic factors, Lymph node metastasis

Core Tip: This is a retrospective study to investigate the survival of gastric cancer patients with positive peritoneal wash cytology but no peritoneal metastasis post-radical gastrectomy and to identify factors associated with long-term prognosis. Our study included 48 such patients and demonstrated that more effective treatment should be established for patients who are diagnosed with pN3b disease and vascular invasion.