Abstract
Background
Peritoneal lavage cytology has been included as part of the staging process in the 13th edition of the Japanese Classification of Gastric Cancer. However, this procedure has neither been studied nor established in our population. We aimed to evaluate its prognostic relevance among our patients with gastric cancer.
Methods
A total of 142 consecutive patients with gastric carcinoma were recruited prospectively. All had histologically proven gastric carcinomas and had undergone laparotomy and intraoperative peritoneal lavage for cytological examination at Singapore General Hospital. The fluid recovered was centrifuged and stained by the Papanicolau method. All patients were followed up with endpoints of cancer recur-rence and mortality.
Results
There were 91 men and 51 women; 36 patients (25.4%) had positive peritoneal lavage. Patients with advanced macroscopic features, presence of vascular invasion, nodal involvement, advanced depth of tumor invasion and metastatic disease tended to have positive lavage, by univariate logistic regression analysis. Despite curative resections, patients with positive cytology had a more dismal disease-free survival (mean, 27 months vs 53 months; P < 0.0001 by log rank test) and higher recurrence rate (54.5% vs 19.3%; P = 0.007 by log rank test). There was also a trend towards earlier recurrences (median, 8 months vs 11 months; P = 0.37). By multivariate Cox regression stepwise analysis, advanced depth of tumor invasion and positive lavage cytology were found to be independent poor prognostic factors for disease-free survival.
Conclusion
Positive peritoneal lavage cytology correlated well with advanced features of gastric cancer. It is an independent poor prognostic factor and the procedure should be routinely performed. Integration of lavage status into our current staging systems may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer in our population.
Article PDF
Similar content being viewed by others
References
E Bando Y Yonemura Y Takeshita et al. (1999) ArticleTitleIntraoperative lavage for cytological examination in 1297 patients with gastric carcinoma Am J Surg 178 256–62 Occurrence Handle10.1016/S0002-9610(99)00162-2 Occurrence Handle10527450 Occurrence Handle1:STN:280:DyaK1MvlsVGktg%3D%3D
CC Wu JT Chen MC Chang et al. (1997) ArticleTitleOptimal surgical strategy for potentially curative serosa-involved gastric carcinoma with intraperitoneal free cancer cells J Am Coll Surg 184 611–7 Occurrence Handle9179118 Occurrence Handle1:STN:280:ByiA383mt1w%3D
InstitutionalAuthorNameJapanese Research Society for Gastric Cancer (1998) ArticleTitleJapanese classification of gastric carcinoma. 2nd English ed Gastric Cancer 1 11–24
JA Ajani PF Mansfield N Janjan et al. (2004) ArticleTitleMultiinstitutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma J Clin Oncol 22 2774–80 Occurrence Handle15254045 Occurrence Handle1:STN:280:DC%2BD2czltFWnsg%3D%3D
JY Kim HS Bae (2001) ArticleTitleA controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP) Gastric Cancer 4 27–33 Occurrence Handle10.1007/s101200100013 Occurrence Handle11706624 Occurrence Handle1:STN:280:DC%2BD3MnltlKrtg%3D%3D
T Suzuki T Ochiai H Hayashi et al. (1999) ArticleTitlePeritoneal lavage cytology findings as prognostic factor for gastric cancer Semin Surg Oncol 17 103–7 Occurrence Handle10.1002/(SICI)1098-2388(199909)17:2<103::AID-SSU4>3.0.CO;2-Q Occurrence Handle10449681 Occurrence Handle1:STN:280:DyaK1MzotVKnsg%3D%3D
S Abe H Yoshimura H Tabata et al. (1995) ArticleTitleCurative resection of gastric cancer: limitation of peritoneal lavage cytology in predicting the outcome J Surg Oncol 59 226–9 Occurrence Handle7630168 Occurrence Handle1:STN:280:ByqA2MnlsVY%3D
T Boku Y Nakane T Minoura et al. (1990) ArticleTitlePrognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer Br J Surg 77 436–9 Occurrence Handle2340396 Occurrence Handle1:STN:280:By%2BB2MvjvFY%3D
GN Papanicolau (1963) Atlas of exfoliative cytology Harvard University Press Cambridge
T Nakajima M Nishi T Kajitani (1991) ArticleTitleImprovement in treatment results of gastric cancer with surgery and chemotherapy: experience of 9700 cases in the Cancer Institute Hospital, Tokyo Semin Surg Oncol 7 365–72 Occurrence Handle1759085 Occurrence Handle1:STN:280:By2C3c7gtVI%3D
CS Fuchs RJ Mayer (1995) ArticleTitleGastric carcinoma N Engl J Med 333 32–41 Occurrence Handle7776992 Occurrence Handle1:STN:280:ByqB1MrnsF0%3D
SA Hundahl HR Menck EG Mansour (1997) ArticleTitleThe National Cancer Database report on gastric carcinoma Cancer 80 2333–41 Occurrence Handle10.1002/(SICI)1097-0142(19971215)80:12<2333::AID-CNCR15>3.0.CO;2-V Occurrence Handle9404711 Occurrence Handle1:STN:280:DyaK1c%2Fmslaitw%3D%3D
S Maekawa M Saku Y Maehara et al. (1996) ArticleTitleSurgical treatment for advanced gastric cancer Hepatogastroenterology 43 178–86 Occurrence Handle8682459 Occurrence Handle1:STN:280:BymB28fnvVc%3D
S Moriguchi Y Maehara D Korenaga et al. (1992) ArticleTitleRisk factors which predict pattern of recurrence after curative surgery for patients with advanced gastric cancer Surg Oncol 1 341–6 Occurrence Handle10.1016/0960-7404(92)90034-I Occurrence Handle1341269 Occurrence Handle1:STN:280:ByuD2szks1I%3D
Y Iitsuka S Shiota T Matsui et al. (1990) ArticleTitleRelationship between the cytological characteristics of intraperitoneal free cancer cells and the prognosis in patients with gastric cancer Acta Cytol 34 437–42 Occurrence Handle2160771 Occurrence Handle1:STN:280:By%2BB287ktFI%3D
M Ikeguchi A Oka S Tsujitani et al. (1994) ArticleTitleRelationship between area of serosal invasion and intraperitoneal free cancer cells in patients with gastric cancer Anticancer Res 14 2131–4 Occurrence Handle7840512 Occurrence Handle1:STN:280:ByqC2c3ltFI%3D
Y Yonemura N Nojima T Kawamura et al. (1998) Mechanisms of the formation of peritoneal dissemination Y Yonemura (Eds) Peritoneal dissemination. Molecular mechanisms and the latest therapy Maeda Shoten Kanazawa, Japan 1–46
Y Iitsuka S Kaneshima O Tanida et al. (1979) ArticleTitleIntraperitoneal free cancer cells and their viability in gastric cancer Cancer 44 1476–80 Occurrence Handle498022 Occurrence Handle1:STN:280:Bi%2BD2cvlsFA%3D
JA Sampson (1931) ArticleTitleImplantation peritoneal carcinomatosis of ovarian origin Am J Pathol 7 423–43
JJ Bonenkamp I Songun J Hermans et al. (1996) ArticleTitlePrognostic value of positive cytology findings from abdominal washings in patients with gastric cancer Br J Surg 83 672–4 Occurrence Handle8689216 Occurrence Handle1:STN:280:BymB1MnisFU%3D
N Hayes J Wayman V Wadehra et al. (1999) ArticleTitlePeritoneal cytology in the surgical evaluation of gastric carcinoma Br J Cancer 79 520–4 Occurrence Handle10.1038/sj.bjc.6690081 Occurrence Handle10027323 Occurrence Handle1:STN:280:DyaK1M7kvFGluw%3D%3D
H Nakanishi Y Kodera A Torii et al. (1997) ArticleTitleDetection of carcinoembryonic antigen-expressing free tumor cells in peritoneal washes from patients with gastric cancer Jpn J Cancer Res 88 687–92 Occurrence Handle9310142 Occurrence Handle1:CAS:528:DyaK2sXltlSrtLc%3D
Y Kodera H Nakanishi Y Yamamura et al. (1998) ArticleTitlePrognostic value and clinical implications of disseminated cancer cells in the peritoneal cavity detected by reverse transcriptase-polymerase chain reaction and cytology Int J Cancer 79 429–33 Occurrence Handle10.1002/(SICI)1097-0215(19980821)79:4<429::AID-IJC20>3.0.CO;2-Z Occurrence Handle9699538 Occurrence Handle1:CAS:528:DyaK1cXltVens74%3D
T Ohta T Terada T Nagakawa et al. (1994) ArticleTitleExpression of pancreatic trypsinogen in human extrapancreatic gastrointestinal carcinomas Oncol Rep 1 759–64 Occurrence Handle1:CAS:528:DyaK2cXltlWiur4%3D
T Fujimura T Ohta H Kitagawa et al. (1998) ArticleTitleTrypsinogen expression and early detection for peritoneal dissemination in gastric cancer J Surg Oncol 69 71–5 Occurrence Handle10.1002/(SICI)1096-9098(199810)69:2<71::AID-JSO5>3.0.CO;2-R Occurrence Handle9808508 Occurrence Handle1:STN:280:DyaK1M%2FitlKqtg%3D%3D
H Nakanishi Y Kodera Y Yamamura et al. (2000) ArticleTitleRapid quantitative detection of carcinoembryonic antigen-expressing free tumour cells in the peritoneal cavity of gastric cancer patients with real-time RT-PCR on the LightCycler Int J Cancer 89 411–7 Occurrence Handle10.1002/1097-0215(20000920)89:5<411::AID-IJC3>3.0.CO;2-5 Occurrence Handle11008202 Occurrence Handle1:CAS:528:DC%2BD3cXnsFWmsrg%3D
S Nomoto A Nakao Y Takeuchi et al. (1995) ArticleTitleIntraoperative peritoneal washing cytology with the rapid immunoperoxidase method using microwave irradiation J Surg Oncol 60 30–4 Occurrence Handle7545254 Occurrence Handle1:STN:280:ByqA1MnhtVw%3D
CC Earle JA Maroun (1999) ArticleTitleAdjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients; revisiting a meta-anlysis of randomized trials Eur J Cancer 35 1059–64 Occurrence Handle10.1016/S0959-8049(99)00076-3 Occurrence Handle10533448 Occurrence Handle1:STN:280:DC%2BD3c%2FgtlKnsw%3D%3D
D Cunningham W Allum S Weeden (2003) ArticleTitlePerioperative chemotherapy in operable gastric and lower oesophageal cancer. A randomised contolled trial of the UK Upper GI Clinical Studies Group (the MAGIC trial ISRCTN 93793971) Eur J Cancer Suppl 1 S18
Y Yonemura X de Arexabala T Fujimura et al. (2001) ArticleTitleIntraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: final results of a randomized controlled study Hepatogastroenterology 48 1776–82 Occurrence Handle11813623 Occurrence Handle1:STN:280:DC%2BD38%2Fos1eguw%3D%3D
T Sautner F Hofbauer D Depisch et al. (1994) ArticleTitleAdjuvant intraperitoneal cisplatin chemotherapy does not improve long-term survival after surgery for advanced gastric cancer J Clin Oncol 12 970–4 Occurrence Handle8164049 Occurrence Handle1:STN:280:ByuB3MnpsVM%3D
A Hagiwara T Takahashi O Kojima et al. (1992) ArticleTitleProphylaxis with carbon-adsorbed mitomycin against peritoneal recurrences of gastric cancer Lancet 339 629–31 Occurrence Handle10.1016/0140-6736(92)90792-2 Occurrence Handle1347336 Occurrence Handle1:STN:280:By2C2sjovVE%3D
M Torisu M Katano Y Kimura et al. (1983) ArticleTitleNew approach to management of malignant ascitis with a streptococcal preparation OK432: improvement of host immunity and prolongation of survival Surgery 93 353–7
Y Yonemura T Fujimura S Fushida et al. (1991) ArticleTitleHyperthermochemotherapy combined with cytoreductive surgery for the treatment of gastric cancer with peritoneal dissemination World J Surg 15 530–6 Occurrence Handle10.1007/BF01675656 Occurrence Handle1891941 Occurrence Handle1:STN:280:By6A28flsVA%3D
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Chuwa, E., Khin, LW., Chan, WH. et al. Prognostic significance of peritoneal lavage cytology in gastric cancer in Singapore. Gastric Cancer 8, 228–237 (2005). https://doi.org/10.1007/s10120-005-0343-6
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10120-005-0343-6