Prognostic Factors in Gastric Cancer Patients with Peritoneal Carcinomatosis

Hyun Il Kim; Tae Kyung Ha; Sung Joon Kwon

doi:10.5230/jgc.2010.10.3.126

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Kim, Ha, and Kwon: Prognostic Factors in Gastric Cancer Patients with Peritoneal Carcinomatosis

Original Article

Journal of Gastric Cancer

Journal of Gastric Cancer 2010; 10(3): 126-132.

Published online: 30 September 2010

DOI: https://doi.org/10.5230/jgc.2010.10.3.126

Prognostic Factors in Gastric Cancer Patients with Peritoneal Carcinomatosis

Hyun Il Kim, Tae Kyung Ha, Sung Joon Kwon

Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea.

Correspondence to: Sung Joon Kwon. Department of Surgery, College of Medicine, Hanyang University, 17, Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. Tel: +82-2-2290-8453, Fax: +82-2-2281-0224, sjkwon@hanyang.ac.kr

Received 19 July 2010 Accepted 4 September 2010

Abstract

Purpose

Peritoneal carcinomatosis (PC) has a dismal prognosis and is occasionally encountered during initial exploration in patients with gastric cancer. The clinicopathological characteristics and survival were analyzed in patients with gastric cancer and PC.

Materials and Methods

Among 2,083 gastric cancer patients who received surgery at the department of surgery, Hanyang University Hospital from 1992 to 2009, 130 patients revealed PC. Ten patients who were lost during follow-up were excluded. The remaining 120 patients were divided into three groups according to the type of surgery. The degree of PC was classified into P1(to the adjacent peritoneum) and P2 (to the distant peritoneum). Various other clinicopathological factors were analyzed using univariate and multivariate survival analyses.

Results

Systemic chemotherapy (SC), type of surgery, lymph node dissection, degree of PC, and presence of ascites were significant prognostic factors. However, age, gender, resection of PC, and Borrmann type were not significant prognostic factors. In a multivariate analysis, SC and the degree of PC were independent prognostic factors. The survival benefit of SC was significant without reference to the type of surgery or degree of PC.

Conclusions

A gastrectomy should be considered feasible in patients with gastric cancer and PC. The independent favorable prognostic factors were SC and a low degree of PC. SC improved the prognosis regardless of operation type and degree of PC.

Keywords: Gastric cancer, Peritoneal carcinomatosis, Prognostic factor

Figures and Tables

Fig. 1

Cumulative survival curves according to resection and chemotherapy. R(+) = gastric resection; R(-) = gastric non-resection; C(+) = chemotherapy conducted group; C(-) = chemotherapy not-conducted group.

Table 1

Univariate survival analysis in peritoneal metastases of gastric cancer

1 ysr = 1-year survival rate; 2 ysr = 2-year survival rate; 5 ysr = 5-year survival rate; SD = standard deviation; PC = peritoneal carcinomatosis; ^*Metastases to the adjacent peritoneum but not the distant peritoneum; ^†Metastases to the distant peritoneum.

Table 2

Multivariate survival analysis in peritoneal metastases of gastric cancer

^*P1 vs P2&3; ^†Performed vs not performed.

Table 3

Survival rate in P1 and P2 group according to the chemotherapy

1 ysr = 1-year survival rate; 2 ysr = 2-year survival rate; 5 ysr = 5-year survival rate; SD = standard deviation; ^*Metastases to the adjacent peritoneum but not the distant peritoneum; ^†P2&3 = metastases to the distant peritoneum.

Table 4

Survival rate according to the chemotherapy in patients who received gastrectomy and bypass surgery or celiotomy only

1 ysr = 1-year survival rate; 2 ysr = 2-year survival rate; 5 ysr = 5-year survival rate; SD = standard deviation.

Table 5

Survival rate according to the chemotherapy in young aged (<65 year) and old aged (≥65 year) patients

1 ysr = 1-year survival rate; 2 ysr = 2-year survival rate; 5 ysr = 5-year survival rate; SD = standard deviation; ^*Chemotherapy conducted group; ^†Chemotherapy not-conducted group.

Table 6

Survival rate according to the chemotherapy and the age

1 ysr = 1-year survival rate; 2 ysr = 2-year survival rate; 5 ysr = 5-year survival rate; SD = standard deviation; ^*Young aged (<65 yr) patient who did not received chemotherapy; ^†Old aged (≥65 yr) patient who received chemotherapy.

Table 7

Clinicopathologic characteristics according to the chemotherapy

STG = subtotal gastrectomy; TG = total gastrectomy; D0 = no node dissection; D1 = 1st tier node dissection; D2 = 1st and 2nd tier node dissection; PC = peritoneal carcinomatosis; ^*Chemotherapy conducted group; ^†Chemo therapy not-conducted group; ^‡Metastases to the adjacent peritoneum but not the distant peritoneum; ^§Metastases to the distant peritoneum.

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