Abstract
BackgroundAccurately distinguishing serosal invasion in patients with gastric cancer (GC) prior to surgery can be difficult. Molecular analysis of peritoneal fluid (MAPF) for free cancer cells with higher sensitivity than other methods; however, its prognostic value for GC remains controversial, precluding its application in clinical practice.MethodsPubMed, EMBASE and other databases were systematically searched. Thirty-one studies were eligible for the meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled for overall survival (OS), disease-free survival (DFS) and peritoneal recurrence-free survival (PRF).ResultsThe current meta-analysis focused on patients with GC and negative cytological diagnoses. The results showed that positive MAPF status (MAPF+) led to poorer prognoses for OS (HR 2.59, 95% CI 1.99–3.37), DFS (HR 4.92, 95% CI 3.28–7.37) and PRF (HR 2.81, 95% CI 2.12–3.72) compared with negative MAPF status (MAPF-). Moreover, among the patients with GC who received curative treatment, the MAPF+ patients had poorer prognoses for OS (HR 3.27, 95% CI 2.49–4.29), DFS (HR 3.90, 95% CI 2.74–5.57) and PRF (HR 5.45, 95% CI 3.70–8.03). A meta-analysis of multivariate-adjusted HRs demonstrated that MAPF+ status was an independent prognostic factor for patients with GC who underwent curative treatment (OS: HR 2.19, 95% CI 1.47–3.28; PRF: HR 3.44, 95% CI 2.01–5.87). Using the identical target genes (CEA, CEA/CK20) as molecular markers, the patients with GC who were MAPF+ had significantly worse prognoses for OS (CEA: HR 3.03, 95% CI 2.29–4.01; CEA/CK20: HR 4.24, 95% CI 2.42–7.40), DFS (CEA: HR 3.99, 95% CI 2.24–7.12; CEA/CK20: HR 4.31, 95% CI 1.49–2.48) and PRF (CEA: HR 4.45, 95% CI 2.72–7.31; CEA/CK20: HR 6.46, 95% CI 3.62–11.55) than the patients who were MAPF-.Conclusion/SignificanceThe above results demonstrate that MAPF could be a prognostic indicator for patients with GC who have a negative cytological diagnosis and/or are receiving curative treatment. MAPF could provide clinicians with additional prognostic information that could aid in developing individualized treatment plans prior to surgery. The widely used target genes CEA, CEA/CK20 were confirmed to be valuable MAPF markers for predicting the prognosis of GC.
Highlights
Gastric cancer (GC) remains one of the most common causes of cancer-related mortality worldwide
The results showed that positive Molecular analysis of peritoneal fluid (MAPF) status (MAPF+) led to poorer prognoses for overall survival (OS) (HR 2.59, 95% confidence intervals (CIs) 1.99–3.37), disease-free survival (DFS) (HR 4.92, 95% CI 3.28–7.37) and peritoneal recurrence-free survival (PRF) (HR 2.81, 95% CI 2.12–3.72) compared with negative MAPF status (MAPF-)
A meta-analysis of multivariate-adjusted Hazard ratios (HRs) demonstrated that MAPF+ status was an independent prognostic factor for patients with GC who underwent curative treatment (OS: HR 2.19, 95% CI 1.47–3.28; PRF: HR 3.44, 95% CI 2.01–5.87)
Summary
Gastric cancer (GC) remains one of the most common causes of cancer-related mortality worldwide. Patients who undergo minimally invasive procedures recover more quickly than patients who undergo conventional surgery or extended resection. Minimal amounts of residual cancer could result in tumor recurrence and poor prognosis, which may elevate the risk of recurrence and result in a need to undergo addittional operations [2,3,4,5]; as such, patients may be warry in opting for minimally invasive surgery. The ability to pre- and postoperatively predict occult micrometastasis would be extremely valuable for developing individualized treatment plans and in choosing an adjuvant chemotherapy (AC), which may be of additional benefit to patients with GC. Distinguishing serosal invasion in patients with gastric cancer (GC) prior to surgery can be difficult. Molecular analysis of peritoneal fluid (MAPF) for free cancer cells with higher sensitivity than other methods; its prognostic value for GC remains controversial, precluding its application in clinical practice
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