Free intraperitoneal tumor cells and outcome in gastric cancer patients: a systematic review and meta-analysis
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Mathieu Pecqueux1,*, Johannes Fritzmann1,*, Mariam Adamu1, Kristian Thorlund2, Christoph Kahlert1, Christoph Reißfelder1, Jürgen Weitz1 and Nuh N. Rahbari1
1 Department for Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany
2 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
* These authors contributed equally to this work
Nuh N. Rahbari, email:
Keywords: free intraperitoneal tumor cells, peritoneal lavage, gastric cancer, prognosis
Received: July 24, 2015 Accepted: August 22, 2015 Published: September 10, 2015
Purpose: Despite continuously improving therapies, gastric cancer still shows poor survival in locally advanced stages with local recurrence rates of up to 50% and peritoneal recurrence rates of 17% after curative surgery. We performed a systematic review with meta-analyses to clarify whether positive intraperitoneal cytology (IPC) indicates a high risk of disease recurrence and poor overall survival in gastric cancer.
Methods: Multiple databases were searched in December 2014 to identify studies on the prognostic significance of positive intraperitoneal cytology in gastric cancer, including: Medline, Biosis, Science Citation Index, Embase, CCMed and publisher databases. Hazard ratios (HR) and associated 95% confidence intervals (CI) were extracted from the identified studies. A meta-analysis was performed using a random-effects model on overall survival, disease-free survival and peritoneal recurrence free survival.
Results: A total of 64 studies with a cumulative sample size of 12,883 patients were included. Cytology, quantitative real time polymerase chain reaction (PCR) or both were performed in 35; 21 and 8 studies, respectively. Meta analyses revealed free intraperitoneal tumor cells (FITC) to be associated with poor overall survival in univariate (HR 3.27; 95% CI 2.82 - 3.78]) and multivariate (HR 2.45; 95% CI 2.04 - 2.94) analysis and poor peritoneal recurrence free survival in univariate (4.15; 95% CI 3.10 - 5.57) and multivariate (3.09; 95% CI 2.02 - 4.71) analysis. Subgroup analysis showed this effect to be independent of the detection method, Western or Asian origin or the time of publication.
Conclusions: FITC oder positive peritoneal cytology is associated with poor survival and increased peritoneal recurrence in gastric cancer.
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