Impact of preoperative chemotherapy as initial treatment for advanced gastric cancer with peritoneal metastasis limited to positive peritoneal lavage cytology (CY1) or localized peritoneal metastasis (P1a): a multi-institutional retrospective study

Toshifumi Yamaguchi^{1

2}, Atsuo Takashima³, Kengo Nagashima⁴, Masanori Terashima⁵, Masaki Aizawa⁶, Manabu Ohashi⁷, Ryo Tanaka⁸, Tatsuya Yamada⁹, Takahiro Kinoshita¹⁰, Hisayuki Matsushita¹¹, Koshiro Ishiyama¹², Kei Hosoda¹³, Yasuhiro Yuasa¹⁴, Shusuke Haruta¹⁵, Naoki Kakihara¹⁶, Kazuhiro Nishikawa¹⁷, Gen Yunome¹⁸, Taroh Satoh¹, Takeo Fukagawa¹⁹, Hitoshi Katai²⁰, Narikazu Boku²

Affiliations

¹ Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Japan.
² Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
³ Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. atakashi@ncc.go.jp.
⁴ Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
⁵ Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
⁶ Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
⁷ Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan.
⁸ Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Takatsuki, Japan.
⁹ Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
¹⁰ Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
¹¹ Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
¹² Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
¹³ Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Tokyo, Japan.
¹⁴ Department of Gastroenterological Surgery, Tokushima Red Cross Hospital, Komatsu, Japan.
¹⁵ Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
¹⁶ Department of Surgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
¹⁷ Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁸ Department of Surgery, Sendai Medical Center, Sendai, Japan.
¹⁹ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
²⁰ Division of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.

PMID: 33179192
DOI: 10.1007/s10120-020-01137-6

Multicenter Study

Impact of preoperative chemotherapy as initial treatment for advanced gastric cancer with peritoneal metastasis limited to positive peritoneal lavage cytology (CY1) or localized peritoneal metastasis (P1a): a multi-institutional retrospective study

Toshifumi Yamaguchi et al. Gastric Cancer. 2021 May.

. 2021 May;24(3):701-709.

doi: 10.1007/s10120-020-01137-6. Epub 2020 Nov 11.

Authors

Affiliations

¹ Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Japan.
² Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
³ Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. atakashi@ncc.go.jp.
⁴ Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
⁵ Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
⁶ Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
⁷ Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan.
⁸ Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Takatsuki, Japan.
⁹ Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
¹⁰ Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
¹¹ Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
¹² Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
¹³ Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Tokyo, Japan.
¹⁴ Department of Gastroenterological Surgery, Tokushima Red Cross Hospital, Komatsu, Japan.
¹⁵ Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
¹⁶ Department of Surgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
¹⁷ Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁸ Department of Surgery, Sendai Medical Center, Sendai, Japan.
¹⁹ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
²⁰ Division of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.

PMID: 33179192
DOI: 10.1007/s10120-020-01137-6

Abstract

Background: Gastric cancer (GC) patients with peritoneal metastasis are defined as stage IV in the Japanese classification of GC. For patients with peritoneal metastasis limited to positive peritoneal lavage cytology (CY1) and/or localized peritoneal metastasis (P1a), gastrectomy followed by S1 monotherapy is one of the most widely accepted therapeutic strategy in Japan. This study investigated the efficacy of preoperative chemotherapy as initial treatment in GC patients with CY1 and/or P1a.

Methods: We retrospectively reviewed GC patients diagnosed with CY1 and/or P1a at 34 institutions in Japan between 2008 and 2012. Selection criteria were: adenocarcinoma, no distant metastasis except CY1 or P1a, and no prior treatment. The subjects were divided into an Initial-Chemotherapy group and an Initial-Surgery group, according to the initial treatment.

Results: A total of 824 patients were collected and 713 eligible patients were identified for this study. As the initial treatment, 150 patients received chemotherapy (Initial-Cx), and 563 patients underwent surgery (Initial-Sx). Initial-Cx regimens were cisplatin plus S1/docetaxel plus cisplatin plus S1/others (n = 90/37/23). Both overall survival (OS) and progression-free survival (PFS) were similar between the Initial-Cx and Initial-Sx groups (median OS 24.8 and 24.0 months, HR 1.07, 95% CI 0.87-1.3; median PFS 14.9 and 13.9 months, HR 1.04, 95% CI 0.85-1.27). The 5-year OS rates were 22.3% in the Initial-Cx group and 21.5% in the Initial-Sx group.

Conclusions: Although, the preoperative chemotherapy did not show a survival benefit for GC patients with CY1 and/or P1a, initial-Cx showed favorable survival in patients who converted to P0 and CY0.

Keywords: Gastric cancer; Peritoneal metastasis; Preoperative chemotherapy.

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References

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Impact of preoperative chemotherapy as initial treatment for advanced gastric cancer with peritoneal metastasis limited to positive peritoneal lavage cytology (CY1) or localized peritoneal metastasis (P1a): a multi-institutional retrospective study

Affiliations

Impact of preoperative chemotherapy as initial treatment for advanced gastric cancer with peritoneal metastasis limited to positive peritoneal lavage cytology (CY1) or localized peritoneal metastasis (P1a): a multi-institutional retrospective study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous