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. 2020 Aug 16;4(6):660-666.
doi: 10.1002/ags3.12386. eCollection 2020 Nov.

An ascites grading system for predicting the prognosis of gastric cancer with peritoneum dissemination

Michitaka Honda  1   2 , Hidetaka Kawamura  1   2 , Hiroshi Kobayashi  1   2 , Koichi Takiguchi  3 , Atsushi Muto  4 , Shigeru Yamazaki  5 , Yasushi Teranishi  2 , Satoru Shiraso  6 , Koji Kono  7 , Soshi Hori  1   2 , Takahiro Kamiga  8 , Toshiyasu Iwao  9 , Naoyuki Yamashita  10
Affiliations

An ascites grading system for predicting the prognosis of gastric cancer with peritoneum dissemination

Michitaka Honda et al. Ann Gastroenterol Surg. .

Abstract

Aim: Gastric cancer with peritoneum dissemination is intractable with surgical resection. The evaluation of the degree of dissemination using computed tomography (CT) is difficult. We focused on the amount of ascites based on CT findings and established a scaling system to predict these patients' prognoses.

Methods: We extracted individual data from a population-based cohort. Patients diagnosed with histologically proven gastric adenocarcinoma with peritoneum dissemination were enrolled. Two raters evaluated the CT images and determined the grade of ascites in each patient: grade 0 indicated no ascites in all slices; grade 1 indicated ascites detected only in the upper or lower abdominal cavity; grade 2 indicated ascites detected in both the upper and lower abdominal cavities; and grade 3 indicated ascites extending continuously from the pelvic cavity to the upper abdominal cavity. We evaluated the relationship between the ascites grade and survival time. After adjusting for other clinical factors, we calculated hazard ratios of each ascites grade.

Results: A total of 718 patients were enrolled. The number of patients with grades 0, 1, 2, and 3 were 303, 223, 94, and 98, respectively. The median overall survival times were 16.0, 8.7, 5.4, and 3.0 months for ascites on CT grades 0, 1, 2, and 3, respectively (P < .001). The adjusted hazard ratios for the survival time were 1.74 (1.33-2.26, P < .001), 3.20 (2.25-4.57, P < .001), and 4.76 (3.16-7.17, P < .001) for grades 1, 2, and 3, respectively.

Conclusion: We established a new grading system of pretreatment ascites to better predict the prognosis of gastric cancer.

Keywords: ascites; gastric cancer; peritoneal dissemination; prognosis.

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Conflict of interest statement

Conflict of Interest: Authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Patients’ enrollment. All of 718 patients were extracted from the population‐based cohort of stage IV gastric cancer
Figure 2
Figure 2
Survival curve of each ascites grade. Overall survival curves using for each AC grade using Kaplan‐Meier's methods
See this image and copyright information in PMC

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