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.
Highlights
Peritoneal dissemination is the most common pattern of recurrence in gastric cancer, even after a potentially curative resection
Current knowledge on intraperitoneal free cancer cell (IFCC) positivity in gastric cancer demonstrates that these cells are associated with a poor prognosis and advanced oncologic stages
The aim of this study was to perform a systematic review and meta-analysis, investigating patients positive for IFCCs detected via different methods, regarding the neoplasm oncologic stage, recurrence rates, grade of cellular differentiation, and survival rates and to analyze the clinical significance of IFCCs with regard to prognosis
Summary
Peritoneal dissemination is the most common pattern of recurrence in gastric cancer, even after a potentially curative resection. This characteristic may be attributable to possible intraperitoneal dissemination of malignant cells already present at the time of surgery or to surgical manipulations. High recurrence rates, mainly due to peritoneal dissemination, and poor median survival are associated with cytology detection [1,2,3] Based on these data, the Japanese Classification of Gastric Carcinoma: 3rd English Edition [4] and the 7th Edition of the AJCC Cancer Staging Manual: Stomach [5] consider conventional cytology positivity in peritoneal fluid to be an indicator of stage IV disease.
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