Prognostic factors and efficacy of postoperative chemotherapy in patients with gastric cancer with positive peritoneal cytology after gastrectomy

doi:10.4251/wjgo.v17.i9.110245

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Oncol. Sep 15, 2025; 17(9): 110245
Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.110245

Prognostic factors and efficacy of postoperative chemotherapy in patients with gastric cancer with positive peritoneal cytology after gastrectomy

Yoichi Sugiyama, Kazuaki Tanabe, Senichiro Yanagawa, Hirofumi Tazawa, Kazuhiro Toyota, Mikihiro Kano, Toshihiro Misumi, Masayuki Shishida, Keisuke Okano, Ryuichi Hotta, Hiroshi Ota, Yasuhiro Imaoka, Toshikatsu Fukuda, Shinya Takahashi, Hideki Ohdan

Yoichi Sugiyama, Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Japan

Kazuaki Tanabe, Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima 734-8551, Japan

Senichiro Yanagawa, Department of Surgery, JA Onomichi General Hospital, Onomichi 722-8508, Japan

Hirofumi Tazawa, Department of Surgery, Kure Medical Center, Chugoku Cancer Center, Kure 737-0023, Japan

Kazuhiro Toyota, Department of Surgery, Hiroshima Memorial Hospital, Hiroshima 730-0802, Japan

Mikihiro Kano, Department of Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan

Toshihiro Misumi, Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan

Masayuki Shishida, Department of Surgery, JR Hiroshima Hospital, Hiroshima 732-0057, Japan

Keisuke Okano, Department of Surgery, Miyoshi Central Hospital, Miyoshi 728-8502, Japan

Ryuichi Hotta, Department of Surgery, NHO Higashihiroshima Medical Center, Higashihiroshima 739-0041, Japan

Hiroshi Ota, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan

Yasuhiro Imaoka, Department of Surgery, JA Yoshida General Hospital, Akitakata 731-0595, Japan

Toshikatsu Fukuda, Department of Surgery, Chugoku Rosai Hospital, Kure 737-0193, Japan

Shinya Takahashi, Department of Surgery, Graduate School of Biochemical and Health Science, Hiroshima University, Hiroshima 734-8551, Japan

Author contributions: Sugiyama Y wrote this manuscript; Tanabe K designed the research; Yanagawa S, Tazawa H, Toyota K, Kano M, Misumi T, Shishida M, Okano K, Hotta R, Ota H, Imaoka Y, and Fukuda T collected the patient’s data; Takahashi S and Ohdan H was responsible for the revision of the manuscript for important intellectual content. All authors approved the final version of manuscript.

Institutional review board statement: This study was approved by the Ethics Committee of JA Hiroshima General Hospital, No. 23-27.

Informed consent statement: The Institutional Review Board of JA Hiroshima General Hospital approved this retrospective study and waived the need for individual informed consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data supporting the findings of this study are available upon reasonable request from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Kazuaki Tanabe, Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan. ktanabe2@hiroshima-u.ac.jp

Received: June 3, 2025
Revised: June 24, 2025
Accepted: July 24, 2025
Published online: September 15, 2025
Processing time: 104 Days and 20.1 Hours

Abstract

BACKGROUND

Peritoneal lavage cytology-positive (CY1) gastric cancer (stage IV) has a poor prognosis, though some cases fare better. Therefore, identifying prognostic factors and an optimal treatment strategy is crucial.

AIM

To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1, and to evaluate the optimal postoperative chemotherapy regimen.

METHODS

This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy, excluding those with macroscopic peritoneal dissemination. Data from 13 institutions (2015-2019) were reviewed.

RESULTS

Overall, 82 patients met the inclusion criteria. The median overall survival was 22.8 months, and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors. The 5-year survival rate was 82.4% for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8% for those with S-1 monotherapy or a cisplatin-based regimen. Median overall survival was not reached in the fluoropyrimidine + docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group. Chemotherapy regimen was an independent prognostic factor (hazard ratio = 5.47, P = 0.004). The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%, with significantly more patients achieving a relative dose intensity ≥ 80% than in the S-1 monotherapy or cisplatin-based group (P = 0.001).

CONCLUSION

Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer. Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.

Keywords: Gastric cancer; Peritoneal lavage cytology-positive; Chemotherapy; Prognostic factor; Treatment strategy; Cancer statistics; Survival

Core Tip: This multicenter retrospective cohort study identifies key prognostic factors in cytology-positive gastric cancer patients undergoing gastrectomy. Diffuse-type histology and absence of postoperative chemotherapy were independent poor prognostic indicators. Critically, combination chemotherapy with fluoropyrimidine plus docetaxel or oxaliplatin significantly improved survival, with a 5-year survival rate of 82.4% vs 21.8% for S-1 or cisplatin-based regimens. The chemotherapy regimen was an independent predictor of overall survival. These findings highlight the importance of intensive postoperative chemotherapy in improving outcomes for this high-risk population.