Abstract
BackgroundAlthough 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.MethodsClinical 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.ResultsIn 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.ConclusionsThere 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.
Highlights
Patients with positive lavage cytology (CY1) are classified as having stage IV disease, longterm survival without other unresectable factors (P0CY1) has been reported
We reviewed our clinical experience of the treatment outcomes and any subsequent problems encountered in patients with CY1 gastric cancer to evaluate an appropriate therapeutic strategy
This study investigated the effect of the initial treatment strategy selected on prognosis in patients with CY1 gastric cancer
Summary
Patients with positive lavage cytology (CY1) are classified as having stage IV disease, longterm 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. Patients with advanced gastric cancer usually undergo curative intent gastrectomy with adjuvant chemotherapy. There are several reports suggesting that survival is better in patients with positive cytology without other unresectable factors (P0CY1) than in those with macroscopic peritoneal dissemination [3, 4]. It has been reported that surgery combined with adjuvant chemotherapy may have a survival benefit in patients with CY1 gastric cancer, and S-1-based chemotherapy is usually administered following gastrectomy [5]. Several recent reports show that a change from positive to negative cytology status following chemotherapy or being able to perform conversion surgery can improve the survival rate [6].
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