Abstract
The peritoneum is a common metastatic site in gastric cancer. This systematic review provides an overview of the incidence, risk factors and survival of synchronous peritoneal metastases from gastric cancer. A systematic search was performed to identify studies wherein the incidence, risk factors and survival of gastric cancer with peritoneal metastases were investigated. Of all 38 potentially eligible studies, 17 studies were included based on the eligibility criteria. The incidence of synchronous gastric peritoneal metastases was reviewed for population-based studies (10–21%), for observational cohort studies (2–15%) and for surgical cohort studies (13–40%). Potential risk factors for synchronous gastric peritoneal metastases were younger age, non-cardia gastric cancer, female sex, signet ring cell carcinoma, diffuse type histology or linitis plastica, T4 stage, Hispanic ethnicity and more than one metastatic location. Synchronous peritoneal metastases are commonly diagnosed in patients with gastric cancer with an incidence up to 21% in recent population-based studies. Furthermore, prognosis of patients with gastric peritoneal metastases is poor with median overall survival ranging from 2 to 9 months. The high incidence and poor prognosis require intensive research on diagnostic features and effective treatment options to improve survival.
Highlights
Gastric cancer is one of the most common cancers worldwide with an incidence of over one million cases in 2020
Several studies investigating the effect of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with gastric, colorectal and ovarian peritoneal metastases have suggested an improvement in survival in carefully selected patients [4,5,6,7]
Risk factors for gastric peritoneal metastases were reported in four studies [15,16,17,18]
Summary
Gastric cancer is one of the most common cancers worldwide with an incidence of over one million cases in 2020. Several studies investigating the effect of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with gastric, colorectal and ovarian peritoneal metastases have suggested an improvement in survival in carefully selected patients [4,5,6,7]. A randomised controlled trial (PERISCOPE II, NCT03348150) currently enrols gastric cancer patients with isolated limited peritoneal metastases to investigate whether CRS-HIPEC provides a survival benefit compared to systemic chemotherapy alone [8,9]. In patients with HER2-positive gastric cancer, the addition of trastuzumab may be considered as the randomised controlled ToGa-trial showed that this prolonged survival in advanced gastric cancer as compared to systemic chemotherapy alone [13]
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