Presence Of Peritoneal Carcinomatosis Research Articles

Animal models of colorectal peritoneal metastasis.

Colorectal cancer remains an important cause of mortality worldwide. The presence of peritoneal carcinomatosis (PC) causes significant symptoms and is notoriously difficult to treat. Therefore, informative preclinical research into the mechanisms and possible novel treatment options of colorectal PC is essential in order to improve the prognostic outlook in these patients. Several syngeneic and xenograft animal models of colorectal PC were established, studying a wide range of experimental procedures and substances. Regrettably, more sophisticated models such as those giving rise to spontaneous PC or involving genetically engineered mice are lacking. Here, we provide an overview of all reported colorectal PC animal models and briefly discuss their use, strengths, and limitations.

Pancreaticoduodenectomy with Reconstruction of the Mesentericoportal Vein by the Parietal Peritoneum: 'Safi Dokmak Vascular Graft'.

Venous resections are frequent during hepatopancreatobiliary (HPB) surgery and a rapidly available graft may be needed, especially if it had not been planned preoperatively.1 (-) 3 Our group recently reported results on the use of the parietal peritoneum (PP) as an autologous substitute graft (ASG) for reconstruction of the mesentericoportal vein (MPV) in 30 patients for the first time.4 METHODS: Between December 2010 and January 2015, a total of 52 patients underwent HPB surgery with venous resection/reconstruction with the PP. The PP was harvested rapidly through the same surgical incision in the same surgical field, and reconstruction was generally performed after the specimen was removed. The ASG was harvested from the PP of the diaphragm (n = 22), the hypochondrium (n = 19), the falciform ligament (n = 6) and the prerenal area (n = 5), and used as a lateral (n = 49) or tubular (n = 3) graft. The presence of peritoneal carcinomatosis was a contraindication. Postoperative anticoagulation was standard and venous patency was assessed by routine computed tomography (CT) scan in all patients. All data were collected prospectively and complications were recorded according to the Clavien-Dindo classification.5 Our experience is illustrated in a patient who underwent pancreaticoduodenectomy with reconstruction of the MPV, using the PP, for recurrent pancreatic adenocarcinoma on an intraductal papillary mucinous neoplasia, and who was treated 5 years ago by distal pancreatectomy. Overall, 32 men and 20 women, mean age 60 years (range 31-83), underwent resection of the pancreas (n = 29), the liver (n = 22), or both (n = 1). Mean size of the ASG was 23 mm (range 10-80), and it was used for reconstruction of the MPV (n = 42), the hepatic veins (n = 5), or the vena cava (n = 5) for malignant disease (98 %). Emergency reconstruction was necessary in six patients due to prolonged vascular occlusion. One non-related mortality was observed (2 %) as a result of septic complications after right hepatectomy. Eight (15 %) complications were greater than grade III of the Clavien-Dindo classification, but there were no PP-related or hemorrhagic complications. Mean hospital stay was 16 days (range 6-48). After a mean follow-up of 11 months (range 1-46), the overall patency rate was 96, 100 % for the lateral graft, and 33 % for the tubular graft. The Safi Dokmak vascular graft using the PP for lateral reconstruction of the MPV may be harvested rapidly with no limitation in size, can be temporarily used, and is inexpensive and safe. Finally, therapeutic anticoagulation is not needed and the theoretical risk of infection is very low.

Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection

The aim of this study was to evaluate the rate of complications from the primary tumour (CPT) requiring surgical or endoscopic intervention during chemotherapy treatment in patients with incurable synchronous stage IV colorectal cancer, the possibility of predicting such complications and their influence on survival. One hundred and twenty-five patients were initially treated with chemotherapy. Patients were grouped on the basis of appearance or not of CPT. We assessed the relation between age, gender, carcinoembryonic antigen (CEA) level, primary tumour location, alkaline phosphatase level, unilobar or bilobar liver involvement, presence of peritoneal carcinomatosis, the number of sites of metastatic disease, the addition of target therapies to chemotherapy, the ability to traverse the tumour with an endoscope and the appearance of complications due to the primary tumour and overall survival. Mean age was 64.9 years, and 89 patients were men. Over a mean of 234 days, 25 patients (20 %) developed a CPT. Eighteen patients required surgery, and seven were treated exclusively by an endoscopic procedure. Mean survival was 15.8 months. We found a statistically relevant correlation between the inability to traverse the tumour with an endoscope and the occurrence of a CPT. There was no statistical differences in survival between both groups, but patients receiving target therapies had better survival. Twenty percent of patients will suffer a CPT during chemotherapy treatment. The inability to pass the tumour with an endoscope can predict the CPT. Survival was only related to the addition of target therapies to chemotherapy.

Role of concurrent systemic chemotherapy and total parental nutrition (TPN) for the treatment of malignant small bowel obstruction (SBO).

e20701 Background: The development of malignant SBO represents a poor prognosis event with limited therapeutic options. Surgical intervention for cases that fail conservative management is associated with high morbidity and mortality. Whether an aggressive approach involving concurrent TPN and systemic chemotherapy has a role in this setting is unknown. The aim of this study was to evaluate the clinical course of patients who receive concomitant TPN and systemic chemotherapy for persistent malignant SBO. Methods: The MD Anderson pharmacy database was queried for adult solid tumor pts who received concurrent TPN and intravenous chemotherapy from 2005-2013 (n = 212). 82 pts met the following inclusion criteria: documented non-duodenal SBO, TPN > = 10 days (definition for failed conservative management), and presence of peritoneal carcinomatosis. Results: 82 pts [62% female, median age 55 (17-85) yrs, tumor types (60% gastrointestinal, 22% gyneocological, 18% other)] were analyzed. Chemotherapy was 5-fluorouracil-based in 39%, taxane-based in 18%, and other in 42%. Median duration of TPN prior to chemotherapy was 8.5 days (1-87) and median duration of TPN was 56 days (10-665). ICU admissions, in hospital death and TPN related complications occurred in 28%, 24% and 33% pts respectively. A radiographic tumor response occurred in 19 (23%) pts. Median overall survival (OS) from the start of TPN and chemotherapy was 3.1 months (95% CI 2.6-5.2) and 1-year OS was 12.6%. In multivariate analysis, the duration of metastatic disease prior to SBO (p = 0.02) and radiographic response (p < 0.01) were significant. Pts with a radiographic response had a median OS of 8.1 months (95% CI 5.0-11.4) compared to 2.6 months (95% CI 1.8-3.7) in non-responders. SBO resolution occurred in 10 pts (12%) and only correlated with a radiographic response to chemotherapy (OR 6.4, 95% CI 1.6-24.9, p = 0.04). Conclusions: Systemic chemotherapy and TPN as a treatment approach for malignant SBO that fails conservative management demonstrates poor success in resolving an SBO and carries both a high morbidity and mortality. This treatment approach for malignant SBO should not represent a standard of care approach.

47. Cytoreduction and hyperthermic intraperitoneal chemotherapy: A feasible and effective option for colorectal cancer patients after emergency surgery in the presence of peritoneal carcinomatosis

47. Cytoreduction and hyperthermic intraperitoneal chemotherapy: A feasible and effective option for colorectal cancer patients after emergency surgery in the presence of peritoneal carcinomatosis

HIF1α is an independent prognostic factor for overall survival in advanced primary epithelial ovarian cancer - a study of the OVCAD Consortium.

PurposeHypoxia is a common phenomenon encountered in solid cancers, leading to chemotherapy resistance and therefore to aggressiveness of the disease. The homeostatic response to hypoxia is mediated by hypoxiainducible factor-1 (HIF-1). The aim of this study was to investigate the impact of HIF1α in patients with primary epithelial ovarian cancer.MethodsIn this multicentric study, 275 patients with advanced primary epithelial ovarian cancer were included. All patients underwent cytoreductive surgery with maximal surgical effort and adjuvant platinum-based chemotherapy. HIF1α expression was analyzed in tissue lysates, using an enzyme-linked immunosorbent assay.ResultsHIF1α was detected in 79.3% of the tissue samples. Patients with increased HIF1α expression (cutoff: 80 pg/mg protein) in tumoral tissue lysates were more likely to have less favorable survival. HIF1α (P=0.009, hazard ratio [HR] 2.505, 95% confidence interval [95% CI] 1.252–5.013) together with International Federation of Gynecology and Obstetrics (III versus IV) (P=0.013, HR 0.540, 95% CI 0.332–0.878), histology (P=0.007, HR 2.748, 95% CI 1.315–5.743), presence of peritoneal carcinomatosis (P=0.014, HR 2.176, 95% CI 1.170–4.046), residual tumor mass (P=0.017, HR 1.641, 95% CI 1.091–2.468), and response to platinum-based chemotherapy (P<0.001, HR 8.131, 95% CI 5.13–12.88) were independent prognosis factors for overall survival. The independent prognostic factors for progression-free survival were International Federation of Gynecology and Obstetrics stage (P=0.01), histological subtypes (P=0.016), and presence of peritoneal carcinomatosis (P<0.05).ConclusionHIF1α overexpression in ovarian cancer is associated with poor overall survival, underlining the importance of hypoxia in this angiogenesis driven disease.

Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy: A Feasible and Effective Option for Colorectal Cancer Patients After Emergency Surgery in the Presence of Peritoneal Carcinomatosis

When peritoneal carcinomatosis (PC) is diagnosed during emergency surgery for colorectal cancer (CRC), further treatment with curative intent may seem futile given the known poor prognosis of both PC and emergency surgery. The aim of the current study was to investigate the feasibility and effectiveness of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRC patients who previously underwent emergency surgery in the presence of PC. All patients with synchronous PC of CRC referred to two tertiary centers between April 2005 and November 2013 were included in this study. Operative, postoperative and survival details were compared between patients presenting in an emergency or elective setting. In total, 149 patients with synchronous PC underwent CRS and HIPEC. Amongst these patients, 36 (24.2%) initially presented with acute symptoms requiring emergency surgery. Acute presentation did not result in a longer interval between the initial operation and HIPEC (2.2 vs. 2.1months; P=0.09). When comparing operative outcomes, no significant differences were found in blood loss (P=0.47), operation time (P=0.39), or completeness of cytoreduction (P=0.97). In addition, complication rates, degree and types of complication did not differ between the groups. Median survival was 36.1months for emergency presentation compared with 32.1 in the elective group (P=0.73). CRS+HIPEC may be performed safely in patients with PC of colorectal origin presenting with acute symptoms requiring emergency surgery. More importantly, the 5-year survival rate in these patients was equal to elective cases. This should be regarded as promising and therefore considered for these patients.

Outcome of surgery for colorectal cancer in the presence of peritoneal carcinomatosis

The detection of peritoneal carcinomatosis (PC) in colorectal cancer patients frequently results in a dilemma with regard to the optimal treatment strategy, especially when PC is encountered unexpectedly during surgery. The aim of this study was to evaluate outcomes of patients undergoing surgery for colorectal carcinoma in the presence of synchronous PC. Patients diagnosed with primary colorectal cancer and synchronous PC in three community hospitals were selected from the Eindhoven Cancer Registry database. Outcomes of postoperative complications, in-hospital mortality and overall survival were collected and analyzed according to the type of intervention performed. Between 1995 and 2009, 169 colorectal cancer patients were diagnosed with synchronous PC, most of them unexpectedly during surgery (n = 130). 142 patients underwent surgery: primary tumor resection (n = 91), palliative procedure (n = 46) or exploration only (n = 5). In-hospital mortality was 41% after palliative surgery and 14% after primary tumor resection. Median survival was 12 weeks after palliative surgery or exploration as opposed to 55 weeks after primary tumor resection. PC is most often encountered unexpectedly during surgery for colorectal cancer. Results of palliative procedures are very poor with a high in-hospital mortality rate and short survival. Resection of the primary tumor can be performed safely with relatively good outcomes but some patients could have benefited from an even more radical approach when the presence of PC would have been diagnosed at an earlier stage. Improvement of imaging techniques to detect PC prior to surgery is therefore urgently needed. Until this is the case, a high index of suspicion is required when subtle signs of PC are encountered.

Do patient- and tumor-related factors predict the peritoneal spread of pancreatic adenocarcinoma?

In pancreatic cancer, the presence of peritoneal carcinomatosis (PC) precludes the possibility of a surgical cure, irrespective of the resectability of the primary tumor. However, peritoneal spread cannot be reliably detected radiographically during preoperative tumor staging. The pancreatic adenocarcinoma database of the Tübingen Comprehensive Cancer Center included 29 patients in whom PC was incidentally detected during the surgery. These patients were retrospectively compared for patient- and tumor-related factors with 29 randomly selected patients without PC who underwent curative resection. Clinical jaundice and diarrhea were more frequently present in patients without PC. The CA 19-9 levels were significantly higher in patients with PC compared to those in patients without PC. No other differences were observed in the patient- or tumor-related factors between the two groups. In pancreatic cancer patients, markedly elevated CA 19-9 levels may serve as surrogate marker for peritoneal dissemination, irrespective of the local resectability of the tumor. In such patients, laparoscopy should be considered as an additional staging tool to rule out peritoneal carcinomatosis.

The role of HE4 in predicting surgical outcome in recurrent ovarian cancer (ROC).

e15556 Background: The value of secondary tumordebulking in ROC remains unclear. Retrospective analyses indicate that patient’s survival is positively affected only when complete macroscopic tumor resection is achieved, so that efforts are internationally focussed on prediction of operability and postoperative tumor residuals. HE4 constitutes a novel biomarker in ovarian cancer, showing so far promising results in the early diagnosis. Primary aim was to evaluate the predictive role of HE4 on surgical outcome and platinum response in 2nd line systemic treatment. Secondary aims were prognostic role of HE4 for overall- (OAS) and progression free survival (PFS). Methods: Plasma was obtained before secondary cytoreductive surgery from 76 patients with ROC. HE4 was detected using ELISA technique Results: In 64.5% of the patients a complete macroscopical tumor debulking could be obtained. A total of 85.5% patients were primary platinum sensitive. Mean HE4 plasma concentration was 195,05 pg/ml (range 36.8-900pg/mLl). HE4 correlated significantly with the presence of peritoneal carcinomatosis (p<0.001) and residual tumor mass after surgery (p= 0.001, HR 12, 61, 95% CI 2.77-57.39). At a HE4 cut off value of 70pg/ml surgical outcome in terms of postoperative residuals could be predicted with a sensitivity of 44.9% and a specificity of 88.9% (95%CI 0.618-0.865). Even though HE4 expression in plasma significantly correlated with OAS (p=0.019, HR=2.77, 95%CI 1.18-6.50) in univariate analysis, it could not retain prognostic significance in multivariate setting. Independent factors for OAS were presence of ascites, residual tumor mass, and initial platinum response. The latter two were also independent prognostic factors for PFS. Conclusions: HE4 appears to be a novel predictive marker for postoperative tumor residuals at secondary tumor debulking in ROC. Larger population studies are warranted to validate these first results.

Clinical Outcome of Tertiary Surgical Cytoreduction in Patients with Recurrent Epithelial Ovarian Cancer

The value of tertiary cytoreductive surgery (TCS) on overall survival (OS) of patients with relapsed epithelial ovarian cancer (ROC) is not well defined. Aim of the present study was to evaluate the operative and clinical outcome after TCS. We systematically evaluated all consecutive patients undergoing TCS. Tumor dissemination pattern, operative morbidity, residual tumor, and survival are described based on a validated intraoperative documentation tool. Predictors of survival and complete tumor resection are analyzed with Cox regression or logistic regression models. Between October 2000 and December 2008, 135 patients (median age, 51 years; range, 22-80 years) of mainly initial FIGO stage ≥ III (106 patients, 78.5%) were evaluated. In 53 patients (39.3%) a complete tumor-resection was obtained. The 1-month operative mortality was 6%. During a median follow-up period of 9.6 months (range, 0.1-75 months), 78 patients (57.8%) died, while 52 patients (38.5%) experienced a further relapse. Median OS was 19.1 months for the total collective (95% confidence interval [95% CI], 14.84-23.35). Median OS was 37.8 months (95% CI, 12.7-62.7) for patients without residual tumor; versus 19.0 months (95% CI, 9.8-28.2) for residual tumor ≤ 1 cm and 6.9 months (95% CI, 3.05-10.7) for residual tumor > 1 cm (P < .001). The presence of peritoneal carcinomatosis did not seem to significantly affect OS. Complete tumor resection was identified as the strongest predictor of OS. Other independent predictors of OS were interval to primary diagnosis ≥ 3 years (hazard ratio [HR], 0.28; 95% CI, 0.14-0.59) and serous papillary histology (HR, 0.23; 95% CI, 0.09-0.56). A total of 42 patients (31.1%) presented at least 1 major complication. Multivariate analysis identified tumor involvement of the middle abdomen and peritoneal carcinomatosis as independent predictors of complete tumor resection. Postoperative tumor residual disease remains the strongest predictor of survival even in TCS setting. To identify the optimal candidates for TCS, the predictive value of ascites and peritoneal carcinomatosis should be confirmed by future prospective trials.

Prognostic Significance of Serum Vascular Endothelial Growth Factor Per Platelet Count in Unresectable Advanced Gastric Cancer Patients

Angiogenesis is one of the crucial steps in various solid tumor growth and metastasis. However, there are limited data regarding the clinical and prognostic significance of serum vascular endothelial growth factor levels per platelet count in unresectable advanced gastric cancer compared with early gastric cancer and healthy volunteers. A total of 181 gastric cancer patients were included and control serum samples were acquired from 113 healthy volunteers. The levels of serum vascular endothelial growth factor were measured using human vascular endothelial growth factor quantitative enzyme-linked immunosorbent assay. Survival curves were calculated using the Kaplan-Meier method and survival comparisons were made by the log-rank test in metastatic gastric cancer. There was a significant correlation between serum vascular endothelial growth factor levels and differentiation of tumor (P = 0.014), stage (P = 0.036). The overall survival (P = 0.0432) and the progression-free survival (P = 0.0116) were significantly shorter in patients with high serum vascular endothelial growth factor per platelet count (≥1.626 pg/10(6)). In the multivariate analysis, the presence of peritoneal carcinomatosis (P = 0.039), serum vascular endothelial growth factor per platelet (P = 0.005) were found to be significantly associated with poor progression-free survival. This study demonstrates that serum vascular endothelial growth factor per platelet count is correlated with poor overall survival and progression-free survival in patients with advanced gastric cancer.

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

To evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management. This is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopy- laparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results. Forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%). Endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.

Medical Management of Malignant Bowel Obstruction: Case Discussions and Review of Literature (713)

1.Discuss three causes of malignant bowel obstruction.2.Recognize the role of medical management of malignant bowel obstruction.3.Review two cases of malignant bowel obstruction that were successfully managed averting the need for surgery. I. Background. Malignant bowel obstruction is one of the most serious complications of colorectal and ovarian cancers. It is often caused by the presence of peritoneal carcinomatosis, intraluminal obstruction, extramural obstruction, secondary to tumor infiltration of the mesenteric plexus or secondary to adverse effects of medications including opioids, anticholinergics, and chemotherapy. Its onset is insidious, extending over many weeks or months with the symptoms of nausea, vomiting, and constipation gradually worsening. II. Case Description. Patient 1 is a 53-year-old female with a history of advanced ovarian cancer who was admitted with nausea, vomiting, and constipation for four days. She reported small bowel movements for the past month with severe abdominal pain. Physical and radiologic examinations were consistent with a cachectic, dehydrated female with high grade small bowel obstruction secondary to peritoneal carcinomatosis. She was treated with a combination of reglan, corticosteroids, octreotide, scopolamine patch, and an aggressive bowel regimen. Her pain was well controlled with an opioid PCA. There was a dramatic response in 24 hours with decreased nasogastric secretions and several bowel movements enabling discharge 3 days after admission. Patient 2 is a 61-year-old with advanced pancreatic cancer who was admitted with severe abdominal pain, nausea and vomiting. Physical and radiologic evaluations were consistent with a high jejunoileal obstruction. She was treated with reglan, corticosteroids, octreotide, and a bowel regimen. The obstruction relieved after 4 days and the patient was able to be discharged home on the fifth day after admission. III. Conclusion. Management of malignant bowel obstruction is one of the most challenging aspects of advanced cancer care. We emphasize medical management in these patients with advanced malignancies as it shortens length of hospital stay and reduces morbidity associated with surgical procedures. The main goal is palliation of symptoms in order to improve a patient's quality of life.

Prevention of Peritoneal Carcinomatosis in Mice by Combining Hyperthermal Intraperitoneal Chemotherapy with the Water Extract from Burr Parsley (Caucalis platycarposL.)

The presence of peritoneal carcinomatosis arising from gastrointestinal and gynecologic tumors is associated with a poor prognosis. Animal models of peritoneal carcinomatosis are important in the evaluation of new treatment modalities. The purpose of this study was to investigate the effect of local chemoimmunotherapy and hyperthermal intraperitoneal chemotherapy (HIPEC) in an animal model of induced peritoneal carcinomatosis in the mouse. For induction of peritoneal carcinomatosis, cells from transplantable mammary carcinoma (MCa) were implanted intraperitoneally in CBA mice. Seven or 3 days before implantation of MCa cells (5 x 10 (3)) the mice were injected with lyophilized water extract from CAUCALIS PLATYCARPOS L. (CPL; 200 mg . kg (-1)) into the abdominal cavity. Immediately after implantation of MCa cells in the abdominal cavity, mice were treated two times with 2 mL of saline that was heated either at 37 degrees C or 43 degrees C (hyperthermal treatment) and cytostatics (doxorubicin 20 mg . kg (-1), cisplatin 10 mg . kg (-1), mitomycin 5 mg . kg (-1), 5-FU 150 mg . kg (-1)). We followed the survival of animals and the side effects appearing with different forms of treatment. CPL increased the life span of mice with peritoneal carcinomatosis without hyperthermal treatment (ILS% = 32.55 %) but showed no effect on the life span of mice with hyperthermal treatment (ILS% = 1.44). Combined treatment with CPL and cytostatics (CIS, DOX, and MIT) significantly affected the development of peritoneal carcinomatosis and increased the survival of mice (ILS% - 37 degrees C = 144.17, 415.46, and 124.13, ILS% - 43 degrees C = 311.42, 200.74, and 138.33, respectively). However, intraperitoneal chemotherapy with 5-FU alone resulted in greater survival time of mice than the treatment with 5-FU + CPL. Results suggest the synergistic effect of hyperthermia, chemotherapy, and immunotherapy. CPL significantly increases the antitumor activity of the hyperthermic chemotherapy and the survival rate of mice with peritoneal carcinomatosis. The stimulative effect of CPL on immunomodulation may be a possible mechanism which protects mice from developing peritoneal carcinomatosis and reduces the side effects of chemotherapy, increasing the life span of mice.

Role of Computed Tomography in the Surgical Management of Patients with Bowel Obstruction Secondary to Recurrent Ovarian Carcinoma

The purpose of this study was to evaluate the potential role of preoperative computed tomography (CT) and clinical features for predicting the outcome of patients with bowel obstruction secondary to ovarian cancer. We identified a subpopulation of patients admitted to the Massachusetts General Hospital for bowel obstruction caused by recurrent ovarian cancer from January 1, 1995, to August 1, 2007. A retrospective review of 10 clinical features and 6 radiographic findings was performed. These findings were analyzed as variables with probable prognostic influence on survival and ability to predict successful palliation, defined as the ability to tolerate a regular or low-residue diet 60 days after discharge. Statistical significance was evaluated using the Fisher exact test. Univariate analysis was done by constructing probability curves according to the Kaplan-Meier method and comparing them by the log-rank test. The study population consisted of 55 patients. Absence of carcinomatosis on CT scan and albumin > or = 3 g/dL were found to be able to predict successful palliation. Platinum resistance, albumin > or = 3 g/dL, and peritoneal carcinomatosis on CT scan were identified as variables with prognostic influence on survival in the univariate analysis. In the Cox regression analysis, only the absence of CT findings of carcinomatosis (P = .009) and albumin > or = 3 g/dL (P = .05) were independently associated with survival. CT scan seems to be helpful in patients with a solitary site as the cause of bowel obstruction. All the patients in our study with this finding had a successful palliation. On the other hand, successful palliation is still feasible in the presence of peritoneal carcinomatosis on CT scan; therefore, this finding alone should not be the reason to avoid surgery in well-selected patients.

Prognostic significance of serum vascular endothelial growth factor per platelet count in gastric cancer patients

e22031 Background: Recent studies have shown that VEGF expression not in tissues but in serum sample is correlated with tumor vascularity, and high serum VEGF levels could predict poor prognosis in cancer patients. However there are limited data regarding the clinical and prognostic significance of serum VEGF levels per platelet count in advanced gastric cancer. In this study, we conducted a study to evaluate the prognostic implication of serum VEGF per platelet count in patients with advanced gastric cancer. Methods: 111 patients with histologically confirmed gastric cancer, 10 patients with early gastric cancer were included and control serum samples were acquired from 10 healthy volunteers. The levels of VEGF were measured using human VEGF quantitative enzyme-linked immunosorbent assay (ELISA). Survival curves were calculated using the Kaplan-Meier method and survival comparisons were made by the log rank test in metastatic gastric cancer. The Cox proportional hazards regression model was utilized for multivariate analyses after univariate analysis defined relevant prognostic variables. Results: A trend toward a significant positive correlation between serum VEGF and platelet counts was observed in patients of AGC (r = 0.477, P = 0.000) and there was a significant correlation between serum VEGF levels and differentiation of tumor (p = 0.014), stage (p = 0.036). The overall survival (log rank, p =0.0432) and the progression free survival (median 4.5 vs. 8.9 months; log rank, p =0.0116) were significantly shorter in patients with high VEGF per platelet count (≥1.626 pg/106). In the multivarivate analysis, performance status (P=0.025), the presence of peritoneal carcinomatosis (P=0.006), serum VEGF per platelet (P=0.005) were found to be significantly associated with poor progression free survival. Conclusions: This study demonstrated that serum VEGF per platelet count are correlated with poor overall survival and progression free survival in patients with advanced gastric cancer. Therefore measurement of serum VEGF per platelet might be useful markers for predicting disease progression and prognosis of advanced gastric cancer. No significant financial relationships to disclose.

Serum VEGF Per Platelet Count as a Prognosis Predicting Factor in Advanced Gastric Cancer Patients

Abstract Background: New blood vessel formation is a crucial step in the process of tumor growth and systemic metastasis. Recent studies have shown that VEGF expression not in tissues but in serum sample is correlated with tumor vascularity, and the high serum VEGF levels could predict poor prognosis in cancer patients. However there has been no data regarding the clinical and prognostic significance of serum VEGF levels per platelet count in advanced gastric cancer. In this study, we conducted a study to evaluate the prognostic implication of serum VEGF per platelet count in the patients with advanced gastric cancer. Methods: 111 patients with histologically confirmed gastric cancer, 35 patients with early gastric cancer were included and control serum samples were acquired from 25 healthy volunteers. The levels of VEGF were measured using human VEGF quantitative enzymelinked immunosorbent assay (ELISA). Survival curves were calculated using the Kaplan-Meier method and survival comparisons were made by the log rank test in metastatic gastric cancer. The Cox proportional hazards regression model was utilized for multivariate analyses after univariate analysis defined relevant prognostic variables. Results: The mean serum VEGF level was higher in the patients of AGC compared to those with EGC and controls (AGC 465 ± 315.8pg/ml; EGC 306 ± 97.8 pg/ml controls 230.8 ± 53.2 pg/ml, P&amp;lt; 0.033). A trend toward a significant positive correlation between serum VEGF and platelet counts was observed in patients of AGC (r = 0.477, P = 0.000, Fig 2) and there was a significant correlation between serum VEGF levels and differentiation of tumor (p = 0.014), stage (p = 0.036). The overall survival (log rank, p =0.0432) and the progression free survival (median 4.5 vs. 8.9 months; log rank, p =0.0116) were significantly shorter in patients with high VEGF per platelet count (≥1.626 pg/106). In the multivarivate analysis, performance status (P=0.025), the presence of peritoneal carcinomatosis (P=0.006), serum VEGF per platelet (P=0.005) were found to be significantly associated with the short progression free survival Conclusions: This study demonstrated that serum VEGF per platelet count is correlated with short overall survival and progression free survival in advanced gastric cancer patients. Therefore, serum VEGF per platelet may be a useful marker for predicting the prognosis of advanced gastric cancer patients.

Peritoneal carcinomatosis in urinary bladder cancer

The objective of this study is to describe the computed tomography findings of peritoneal carcinomatosis of urinary bladder cancer. Patients with urinary bladder cancer were reviewed from patient database of our hospital, and 384 patients with urinary bladder cancer were identified. Computed tomography scans of 105 patients with urinary bladder cancer were retrospectively reviewed. Images were reviewed for presence of peritoneal implant, ascites, solid organ metastases, and retroperitoneal lymphadenopathy. Surgical history and follow-up courses of the patients were reviewed. Computed tomography findings of peritoneal metastases were found in eight (7.6%) patients. Peritoneal involvement was diffuse in three patients and was in the form of implantation in five patients. In two patients, liver metastases were detected; additionally, one patient had accompanying pleural implants and one patient had adrenal gland metastases. Peritoneal involvement was detected in the preoperative stage in five patients. Presence of peritoneal carcinomatosis in cancer patients is an indicator of poor prognosis. Detection of peritoneal involvement in urinary bladder cancer patients can alter treatment strategy and may prevent unnecessary aggressive surgical interventions.

Prognostic Factors for Complete Debulking in Advanced Ovarian Cancer and Its Impact on Survival: An Exploratory Analysis of a Prospectively Randomized Phase III Study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR)

The presence or absence of residual ovarian cancer following an attempt at complete debulking is recognized as one of the most important prognostic factors in women with advanced disease. Standard surgical treatment includes radical debulking of the tumor, bilateral salpingo-oophorectomy, total hysterectomy, omentectomy, and peritoneal debulking. The role of pelvic and para-aortic lymphadenectomy remains uncertain. This study examined the influence of surgical outcome on survival in a multicenter, prospective, randomized phase III trial that compared treatment with cisplatin/ paclitaxel or carboplatin/paclitaxel in 761 adult women with histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stages IIB-IV ovarian cancer. Complete tumor resection led to significantly better overall survival than when any visible tumor remained, even if limited in extent. Although median survival was not reached during 7.5 years of observation, the overall average survival time was 4.7 years. Women with, at most, 1 cm of residual tumor had a median overall survival time of 3.1 years, compared to 2.6 years for those with more than 1 cm of residual tumor. On multivariable logistic regression analysis, the likelihood of complete debulking with no residual gross tumor was significantly less frequent with a higher preoperative tumor load, higher FIGO stage, worse performance status, advanced age, or the presence of peritoneal carcinomatosis. Histological subtype was not a predictor of complete resection. Hospitals performing comprehensive surgical debulking including retroperitoneal lymphadenectomy and peritoneal stripping had a higher rate of complete debulking than other centers (33% vs. 23%), which in turn was associated with markedly improved overall survival (P = 0.045). This effect remained after adjusting for prognostic factors. The persistence of advanced ovarian cancer following surgery appears to be one of the most important independent factors predicting survival. The present findings suggest that aggressive primary surgery that includes complete tumor debulking is advantageous.