Abstract
Despite continuously improving therapies, gastric cancer still shows poor survival in locally advanced stages with local recurrence rates of up to 50% and peritoneal recurrence rates of 17% after curative surgery. We performed a systematic review with meta-analyses to clarify whether positive intraperitoneal cytology (IPC) indicates a high risk of disease recurrence and poor overall survival in gastric cancer. Multiple databases were searched in December 2014 to identify studies on the prognostic significance of positive intraperitoneal cytology in gastric cancer, including: Medline, Biosis, Science Citation Index, Embase, CCMed and publisher databases. Hazard ratios (HR) and associated 95% confidence intervals (CI) were extracted from the identified studies. A meta-analysis was performed using a random-effects model on overall survival, disease-free survival and peritoneal recurrence free survival. A total of 64 studies with a cumulative sample size of 12,883 patients were included. Cytology, quantitative real time polymerase chain reaction (PCR) or both were performed in 35; 21 and 8 studies, respectively. Meta analyses revealed free intraperitoneal tumor cells (FITC) to be associated with poor overall survival in univariate (HR 3.27; 95% CI 2.82 - 3.78]) and multivariate (HR 2.45; 95% CI 2.04 - 2.94) analysis and poor peritoneal recurrence free survival in univariate (4.15; 95% CI 3.10 - 5.57) and multivariate (3.09; 95% CI 2.02 - 4.71) analysis. Subgroup analysis showed this effect to be independent of the detection method, Western or Asian origin or the time of publication. FITC oder positive peritoneal cytology is associated with poor survival and increased peritoneal recurrence in gastric cancer.
Highlights
Every year around one million new cases of gastric cancer are diagnosed globally
free intraperitoneal tumor cells (FITC) oder positive peritoneal cytology is associated with poor survival and increased peritoneal recurrence in gastric cancer
FITC were detected by cytology in 43 (67%) studies (38 studies used Papanicolaou staining, 5 studies used H&E staining), by immunocytochemistry (ICC) in 5 (8%) studies and by RT-polymerase chain reaction (PCR) in 29 (45%) studies (Table 2)
Summary
Every year around one million new cases of gastric cancer are diagnosed globally. In 2012, 723,000 people died from gastric cancer, ranking it the 4th most common cancer-related cause of death. FITC are found in 6-49% of gastric cancer patients considered for curative surgery [10,11,12,13], it’s predictive and prognostic value has remained unclear due to inconsistent detection techniques and results of the individual studies. This clinical uncertainty is reflected by inconsistent recommendations made by different guidelines on the use of FITC in the management of gastric cancer [1,2,3, 14]. To clarify the role of intraperitoneal lavage cytology as a prognostic biomarker in gastric cancer, we performed a systematic review with meta-analyses of studies on the prognostic significance of FITC detection in peritoneal lavage samples of patients with gastric cancer considered for curative therapy
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