Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2020; 12(5): 569-581
Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.569
Gastric cancer with peritoneal metastases: Efficiency of standard treatment methods
Roman Yarema, Мyron Оhorchak, Petro Hyrya, Yuriy Kovalchuk, Victor Safiyan, Ivan Karelin, Severyn Ferneza, Markiyan Fetsych, Myron Matusyak, Yuriy Oliynyk, Тaras Fetsych
Roman Yarema, Severyn Ferneza, Markiyan Fetsych, Yuriy Oliynyk, Тaras Fetsych, Department of oncology and Radiology, Danylo Halytsky Lviv National Medical University, Lviv 79010, Ukraine
Мyron Оhorchak, Petro Hyrya, Yuriy Kovalchuk, Victor Safiyan, Ivan Karelin, Myron Matusyak, Department of Abdominal Surgery, Lviv Oncological Regional Treatment and Diagnostic Center, Lviv 79000, Ukraine
Author contributions: Yarema R designed and performed the research and wrote the paper; Оhorchak M designed the research and supervised the report; Ferneza S, Fetsych M, Oliynyk Y contributed to the analysis; Hyrya P, Kovalchuk Y, Safiyan V, Karelin I and Matusyak M provided clinical advice; Fetsych T supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Lviv Oncological Regional Treatment and Diagnostic Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Roman Yarema, MD, PhD, Surgical Oncologist, Department of Oncology and Radiology, Danylo Halytsky Lviv National Medical University, 69 Pekarska Street, Lviv 79010, Ukraine. roman.yarema@ukr.net
Received: December 29, 2019
Peer-review started: December 29, 2019
First decision: February 20, 2020
Revised: March 24, 2020
Accepted: March 28, 2020
Article in press: March 28, 2020
Published online: May 15, 2020
Processing time: 136 Days and 11.3 Hours
Abstract
BACKGROUND

Peritoneal metastasis (PM), arising from gastric cancer (GC), is the most common pattern of synchronous and metachronous dissemination and is generally associated with poor prognosis. New therapeutic modalities are being increasingly employed for such patients.

AIM

To develop more advanced methods, it becomes necessary to study the results of existing standard treatment methods in patients with PM in order to perform a comparative analysis of the strategies.

METHODS

A retrospective analysis of the efficiency of standard treatment methods (i.e., palliative chemotherapy, palliative gastrectomy, and the best supportive care) was performed on 200 GC patients with synchronous PM.

RESULTS

The overall survival (OS) rate in 200 GC patients with PM under standard treatment was 5.4 mo. One-year survival occurred in 18.4% of patients. In multivariate analysis, the survival rate was significantly influenced by the following factors: Presence of extraperitoneal metastases, and stage of PM according to both the Japanese Gastric Cancer Association (JGCA) and the peritoneal cancer index (PCI). The median OS and 1-year survival of patients with Р1, P2, and P3 (JGCA) carcinomatosis were 9.8 mo, 6.7 mo, and 4.0 mo, and 47.2%, 18.8%, and 5.1%, respectively. The application of the palliative gastrectomy resulted in an increase in the median OS by up to 17 mo compared to the conservative approach where the value was 8.5 mo (P = 0.05) in patients with Р1 РМ. In patients with Р3, palliative chemotherapy increased the OS by up to 5.6 mo compared to the OS of 3.2 mo (P = 0.0006) for best supportive care. The median OS and 1-year survival of patients with РCI of 1-6, 7-12 and 13+ points were 8.5 mo, 4.2 mo, and 4.1 mo, and 39.8%, 6.7%, and 5.5%, respectively. Palliative gastrectomy increased the median OS to 12.6 mo compared to conservative approach of 8.0 mo (P = 0.03) in patients with РCI of 1-6 points. In patients with РCI 13+ points, only palliative chemotherapy increased the OS to 6.0 mo compared to the OS of 3.4 mo for best supportive care (P = 0.0008).

CONCLUSION

GC patients with PM are characterized by extremely poor prognoses. Long-term survivors were found in the group with PCI of 1-6 points, and there was no survival difference in groups with PCI 7-12 vs PCI 13+ points. Palliative gastrectomy could prove effective in treating patients with early stage PM. The three standard treatment methods are equally effective for moderate stages of PM. In cases with advanced peritoneal carcinomatosis, a significant increase in prognosis was registered only after treatment with palliative chemotherapy.

Keywords: Gastric cancer; Peritoneal metastases; Palliative treatment methods; Peritoneal cancer index

Core tip: This is a retrospective study to evaluate the efficacy of standard treatment methods (i.e., palliative chemotherapy, palliative gastrectomy, and the best supportive care) in gastric cancer patients with peritoneal metastases (PM). Analysis was performed on 200 patients with synchronous PM. Palliative gastrectomy could prove effective in treating patients with early stage PM. The three standard treatment methods are equally effective for moderate stages of PM. In cases with advanced peritoneal carcinomatosis, a significant increase in prognosis was registered only after treatment with palliative chemotherapy.