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Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis

The present study demonstrated prognostic factors for long-term survival in patients after a comprehensive treatment (CHT) for peritoneal metastasis (PM) from gastric cancer (GC). Materials and Methods: Among 419 patients treated with neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), 266 (63...

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Autores principales: Yonemura, Yutaka, Prabhu, Aruna, Sako, Shouzou, Ishibashi, Haruaki, Mizumoto, Akiyoshi, Takao, Nobuyuki, Ichinose, Masumi, Motoi, Shunsuke, Liu, Yang, Nishihara, Kazurou, Brandl, Andreas, Fushida, Sachio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016959/
https://www.ncbi.nlm.nih.gov/pubmed/31906405
http://dx.doi.org/10.3390/cancers12010116
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author Yonemura, Yutaka
Prabhu, Aruna
Sako, Shouzou
Ishibashi, Haruaki
Mizumoto, Akiyoshi
Takao, Nobuyuki
Ichinose, Masumi
Motoi, Shunsuke
Liu, Yang
Nishihara, Kazurou
Brandl, Andreas
Fushida, Sachio
author_facet Yonemura, Yutaka
Prabhu, Aruna
Sako, Shouzou
Ishibashi, Haruaki
Mizumoto, Akiyoshi
Takao, Nobuyuki
Ichinose, Masumi
Motoi, Shunsuke
Liu, Yang
Nishihara, Kazurou
Brandl, Andreas
Fushida, Sachio
author_sort Yonemura, Yutaka
collection PubMed
description The present study demonstrated prognostic factors for long-term survival in patients after a comprehensive treatment (CHT) for peritoneal metastasis (PM) from gastric cancer (GC). Materials and Methods: Among 419 patients treated with neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), 266 (63.5%) patients received complete resection (CC-0) of the macroscopic tumors. In total, 184 (43.9%) patients were treated with postoperative systemic chemotherapy. Results: All patients treated who received incomplete cytoreduction (CC-1) died of GC within 6 years. In contrast, 10- year survival rates (-YSR) of CC-0 resection were 8.3% with median survival time (MST) of 20.5 months. Post-NIPS peritoneal cancer index (PCI) ≤11, and pre-NIPS PCI ≤13 were the significant favorable prognostic factors. Patients with numbers of involved peritoneal sectors ≤5 survived significant longer than those with ≥6. Both negative pre- and post-NIPS cytology was associated with significant favorable prognosis. Multivariate analyses identified pre-PCI (≤13 vs. ≥14), and cytology after NIPS (negative cytology vs. positive cytology) as independent prognostic factors. Ten year-survivors were found in patients with involvement of the greater omentum (9%), pelvic peritoneum (3%), para-colic gutter (13.9%), upper jejunum (5.6%), lower jejunum (5.5%), spermatic cord (21.9%), rectum (9.5%), ureter (6.3%), ovary (6.7%), and diaphragm (7.0%) at the time of cytoreduction. Twenty-one patients survived longer than 5 years, and 17 patients are still alive without recurrence. Conclusions: GC-PM should be removed aggressively, in patients with PCI after NIPS ≤11, PCI before NIPS ≤13, mall bowel PCI ≤2, and complete cytoreduction should be performed for metastasis in ≤5 peritoneal sectors.
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spelling pubmed-70169592020-02-28 Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis Yonemura, Yutaka Prabhu, Aruna Sako, Shouzou Ishibashi, Haruaki Mizumoto, Akiyoshi Takao, Nobuyuki Ichinose, Masumi Motoi, Shunsuke Liu, Yang Nishihara, Kazurou Brandl, Andreas Fushida, Sachio Cancers (Basel) Article The present study demonstrated prognostic factors for long-term survival in patients after a comprehensive treatment (CHT) for peritoneal metastasis (PM) from gastric cancer (GC). Materials and Methods: Among 419 patients treated with neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), 266 (63.5%) patients received complete resection (CC-0) of the macroscopic tumors. In total, 184 (43.9%) patients were treated with postoperative systemic chemotherapy. Results: All patients treated who received incomplete cytoreduction (CC-1) died of GC within 6 years. In contrast, 10- year survival rates (-YSR) of CC-0 resection were 8.3% with median survival time (MST) of 20.5 months. Post-NIPS peritoneal cancer index (PCI) ≤11, and pre-NIPS PCI ≤13 were the significant favorable prognostic factors. Patients with numbers of involved peritoneal sectors ≤5 survived significant longer than those with ≥6. Both negative pre- and post-NIPS cytology was associated with significant favorable prognosis. Multivariate analyses identified pre-PCI (≤13 vs. ≥14), and cytology after NIPS (negative cytology vs. positive cytology) as independent prognostic factors. Ten year-survivors were found in patients with involvement of the greater omentum (9%), pelvic peritoneum (3%), para-colic gutter (13.9%), upper jejunum (5.6%), lower jejunum (5.5%), spermatic cord (21.9%), rectum (9.5%), ureter (6.3%), ovary (6.7%), and diaphragm (7.0%) at the time of cytoreduction. Twenty-one patients survived longer than 5 years, and 17 patients are still alive without recurrence. Conclusions: GC-PM should be removed aggressively, in patients with PCI after NIPS ≤11, PCI before NIPS ≤13, mall bowel PCI ≤2, and complete cytoreduction should be performed for metastasis in ≤5 peritoneal sectors. MDPI 2020-01-01 /pmc/articles/PMC7016959/ /pubmed/31906405 http://dx.doi.org/10.3390/cancers12010116 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Yonemura, Yutaka
Prabhu, Aruna
Sako, Shouzou
Ishibashi, Haruaki
Mizumoto, Akiyoshi
Takao, Nobuyuki
Ichinose, Masumi
Motoi, Shunsuke
Liu, Yang
Nishihara, Kazurou
Brandl, Andreas
Fushida, Sachio
Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis
title Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis
title_full Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis
title_fullStr Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis
title_full_unstemmed Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis
title_short Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis
title_sort long term survival after cytoreductive surgery combined with perioperative chemotherapy in gastric cancer patients with peritoneal metastasis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016959/
https://www.ncbi.nlm.nih.gov/pubmed/31906405
http://dx.doi.org/10.3390/cancers12010116
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