Yarema R, Оhorchak М, Hyrya P, Kovalchuk Y, Safiyan V, Karelin I, Ferneza S, Fetsych M, Matusyak M, Oliynyk Y, Fetsych Т. Gastric cancer with peritoneal metastases: Efficiency of standard treatment methods. World J Gastrointest Oncol 2020; 12(5): 569-581 [PMID: 32461788 DOI: 10.4251/wjgo.v12.i5.569]
Corresponding Author of This Article
Roman Yarema, MD, PhD, Surgical Oncologist, Department of Oncology and Radiology, Danylo Halytsky Lviv National Medical University, 69 Pekarska Street, Lviv 79010, Ukraine. roman.yarema@ukr.net
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastrointest Oncol. May 15, 2020; 12(5): 569-581 Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.569
Table 1 Clinical and pathological features of 200 intraperitoneally-disseminated gastric cancer patients
Characteristic
n (%)
Sex
Male
121 (60.5)
Female
79 (39.5)
Primary gastric cancer location
Antral part
56 (28)
Corpus
44 (22)
Proximal part
7 (3.5)
Antral part + corpus
34 (17)
Corpus + proximal part
12 (6)
Subtotal or total lesion
47 (23.5)
Borrmann’s type
Type I
3 (1.5)
Type II
19 (9.5)
Type III
106 (53)
Type IV
72 (36)
Tumor histology
G1
5 (2.5)
G2
12 (6)
G3
54 (27)
G4
98 (49)
Signet ring cell
24 (12)
Mucinous
3 (1.5)
Unknown
4 (2)
Stage of peritoneal carcinomatosis according to Japanese classification (JGCA)
Р0 (Cyt+)
4 (2)
Р1
46 (23)
Р2
40 (20)
Р3
110 (55)
PCI, points [Median = 13 (0-37)]
0 (Cyt+)
4 (2)
1-6
64 (32)
7-12
25 (12.5)
13 and more
104 (52)
Unknown
3 (1.5)
Ascites
Present
87 (43.5)
Absent
113 (56.5)
Extraperitoneal metastases
Present
34 (17)
Absent
166 (83)
Site of extraperitoneal metastases
Liver
10 (29)
Non-regional lymph node
16 (47)
Pleura
4 (12)
Lung + non-regional lymph node
2 (6)
Suprarenal gland
1 (3)
Bones
1 (3)
Table 2 Treatment methods of 200 intraperitoneally-disseminated gastric cancer patients
Treatment modality
n (%)
BSC
Total
105 (52.5)
Only BSC
31 (29.5)
Attempted or non-resectable palliative surgery + BSC
74 (70.5)
Stage of peritoneal carcinomatosis according to JGCA
P0 (Cyt+)
0
P1
20 (19)
P2
23 (21.9)
P3
62 (59.1)
PCI
0 (Cyt+)
0
1-6
31 (29.5)
7-12
13 (12.4)
13 +
60 (57.2)
Unknown
1 (0.9)
Palliative chemotherapy
Total
51 (25.5)
Only palliative chemotherapy
24 (47)
Attempted or non-resectable palliative surgery + palliative chemotherapy
27 (53)
Stage of peritoneal carcinomatosis according to JGCA
P0 (Cyt+)
0
P1
6 (11.8)
P2
9 (17.6)
P3
36 (70.6)
PCI
0 (Cyt+)
0
1-6
9 (17.6)
7-12
8 (15.7)
13 +
32 (62.7)
Unknown
2 (4)
Chemotherapy regimen
CF
19 (37.2)
5-FU
11 (21.6)
CAF
10 (19.6)
XELOX
7 (13.7)
ECF
3 (5.9)
Tegafur
1 (2)
Palliative gastrectomy
Total
44 (22)
Only palliative gastrectomy
40 (91)
Palliative gastrectomy + palliative chemotherapy
4 (9)
Stage of peritoneal carcinomatosis according to JGCA
P0 (Cyt+)
4 (9.1)
P1
20 (45.4)
P2
8 (18.2)
P3
12 (27.3)
PCI
0 (Cyt+)
4 (9.1)
1-6
24 (54.5)
7-12
4 (9.1)
13 +
12 (27.3)
Lymph node dissection
D0, 1
35 (79.5)
D1+, 2
9 (20.5)
Completeness of cytoreduction score
CC-0
9 (20.5)
CC-1
19 (43.2)
CC-2
16 (36.3)
Table 3 Univariate analysis of prognostic factors for 200 intraperitoneally-disseminated gastric cancer patients
n
1-yr survival, %
Median survival in mo
P value
Gender
Male
121
18.4
5.2
0.4
Female
79
18.5
6.5
Age
< 60
100
21.1
6.5
0.26
60+
100
15.4
5.0
Borrmann’s type
I-II
22
34.3
6.8
0.13
III-IV
178
16.5
5.2
Ascites
Absence
113
29.5
6.9
< 0.0001
Presence
87
1.7
4.0
Histology
G1
5
0
3.6
0.64
G2
12
40
6.8
G3
54
13.5
5.6
G4
98
21.2
5.2
Signet ring
24
9.5
6.5
Mucinous
3
0
3.7
Extraperitoneal metastases
No
165
19.7
6.4
0.031
Yes
34
7.7
4.2
JGCA classification
P0 (Cyt+)
4
0
4.0
< 0.0001
P1
46
47.2
9.8
P2
40
18.8
6.7
P3
110
5.1
4.0
PCI
0 (Cyt+)
4
0
4.0
< 0.0001
1-6
64
39.8
8.5
7-12
25
6.7
4.2
13+
104
5.5
4.1
Lymph node dissection
D0, 1
35
31.4
7.5
0.61
D1+, 2
9
50.0
8.9
Cytoreduction score
CC-0
9
22.2
7.5
0.065
CC-1
19
58.2
13.1
CC-2
16
18.8
4.7
Table 4 Efficiency of standard treatment methods, depending on stage of peritoneal carcinomatosis according to the Japanese Gastric Cancer Association
n
1-yr survival, %
Median survival in mo
P value
P1
BSC
20
38.5
8.5
0.12
Palliative chemotherapy
6
33.3
6.7
Palliative gastrectomy
20
61.1
17
BSC
20
38.5
8.5
0.71
Palliative chemotherapy
6
33.3
6.7
BSC
20
38.5
8.5
0.032
Palliative gastrectomy
20
61.1
17
Conservative approach of BSC + palliative chemotherapy
26
37.5
7.8
0.05
Palliative gastrectomy
20
61.1
17
P2
BSC
23
11.7
5
0.56
Palliative chemotherapy
9
22.2
8.4
Palliative gastrectomy
8
37.5
7.5
P3
BSC
62
2.3
3.2
0.003
Palliative chemotherapy
36
7.8
5.6
Palliative gastrectomy
12
8.3
4.7
BSC
62
2.3
3.2
0.2
Palliative gastrectomy
12
8.3
4.7
BSC
62
2.3
3.2
0.0006
Palliative chemotherapy
36
7.8
5.6
Table 5 Efficiency of standard treatment methods based on peritoneal cancer index level
n
1-year survival, %
Median survival, mo
P value
PCI 1-6
BSC
31
30.8
8.3
0.089
Palliative chemotherapy
9
33.3
6.9
Palliative gastrectomy
24
54.5
12.6
BSC
31
30.8
8.3
0.94
Palliative chemotherapy
9
33.3
6.9
BSC
31
30.8
8.3
0.045
Palliative gastrectomy
24
54.5
12.6
Conservative approach of BSC + palliative chemotherapy
40
31.5
8.0
0.03
Palliative gastrectomy
24
54.5
12.6
D0,1 lymph node dissection
18
52.9
12.6
0.91
D1+, 2 lymph node dissection
6
60.0
17.0
PCI 7-12
BSC
13
0
2.1
0.082
Palliative chemotherapy
8
0
4.3
Palliative gastrectomy
4
50.0
4.2
PCI 13+
BSC
60
2.5
3.4
0.004
Palliative chemotherapy
32
8.9
6.0
Palliative gastrectomy
12
8.3
4.7
BSC
60
2.5
3.4
0.26
Palliative gastrectomy
12
8.3
4.7
BSC
60
2.5
3.4
0.0008
Palliative chemotherapy
32
8.9
6.0
Citation: Yarema R, Оhorchak М, Hyrya P, Kovalchuk Y, Safiyan V, Karelin I, Ferneza S, Fetsych M, Matusyak M, Oliynyk Y, Fetsych Т. Gastric cancer with peritoneal metastases: Efficiency of standard treatment methods. World J Gastrointest Oncol 2020; 12(5): 569-581