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. 2011 Jun 26;2(1):16–23. doi: 10.1007/s13193-011-0074-6

Positive Peritoneal Cytology in Patients with Gastric Cancer: Natural History and Outcome of 291 Patients

James J Mezhir 1, Manish A Shah 2, Lindsay M Jacks 3, Murray F Brennan 1, Daniel G Coit 1, Vivian E Strong 1,✉
PMCID: PMC3373003  PMID: 22696066

Abstract

Background.

Positive peritoneal cytology is a predictor of poor survival in patients with gastric cancer. Our aim is to more clearly define the natural history of this cohort.

Methods.

Review of a prospectively maintained gastric cancer database of patients who had diagnostic laparoscopy with peritoneal washings. Clinicopathologic and treatmentrelated variables were obtained. Univariate and multivariate analyses were performed for factors associated with disease-specific survival (DSS).

Results.

From January 1993 to April 2009, a total of 1241 patients with gastric cancer underwent laparoscopy with peritoneal washings; 291 (23%) had positive cytology. There were 198 patients (68%) who had visible metastases discovered at laparoscopy (M1), and 93 patients (32%) were without gross evidence of advanced disease (M1 Cyt+). The median DSS for the entire cohort was 1 year; for M1, DSS was 0.8 years, and for M1 Cyt+, DSS was 1.3 years. At baseline, independent predictors of worse DSS were poor performance status, M1 disease, and diffuse tumors. Among the subset of patients with M1 Cyt + disease, performance status was the strongest independent predictor of DSS. A total of 48 of the 291 Cyt + patients had repeat staging laparoscopy after chemotherapy. Compared with patients who had persistently positive cytology (n = 21), those who converted to negative cytology (n = 27) had a significant improvement in DSS (2.5 years vs. 1.4 years, P = 0.0003).

Conclusions.

Patients with positive cytology as the only evidence of advanced disease exhibit a poor outcome; however, clearing of Cyt + disease by chemotherapy is associated with a statistically significant improvement in DSS. The role for gastrectomy in patients with positive peritoneal cytology remains uncertain.

Footnotes

Presented at the 63 rd Annual Society of Surgical Oncology Cancer Symposium, St. Louis, Missouri, March 5, 2010, and the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, Orlando, Florida, January 22, 2010.

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