Endo Shunji, Ikenaga Masakazu, Ohta Katsuya, Ueda Masami, Tsuda Yujiro, Kato Ryo, Itakura Hiroaki, Matsuyama Jin, Nishikawa Kazuhiro, Yamada Terumasa
Department of Gastroenterological Surgery, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan.
Department of Surgery, Yao Municipal Hospital, Osaka, Japan.
Surg Today. 2019 Jan;49(1):56-64. doi: 10.1007/s00595-018-1704-1. Epub 2018 Aug 30.
Positive peritoneal lavage cytology for gastric carcinoma cells (CY1) is considered distant metastasis and is classified as Stage IV. However, patients with CY1 comprise a heterogeneous population, and their prognosis varies greatly. The prognostic factors for gastric cancer patients with CY1 were retrospectively reviewed.
The participants were 80 gastric cancer patients with CY1 in our institution encountered between 2005 and 2017. Prognostic factors were analyzed using univariate and multivariate analyses.
The operative procedure was distal gastrectomy for 30 patients, total gastrectomy for 27 patients, staging laparoscopy for 10 patients, gastrojejunostomy for 8 patients, and probe laparotomy for 5 patients. Other distant metastases were recognized in 36 patients. A multivariate analysis revealed that other distant metastases were the strongest independent risk factor for the overall survival (p < 0.0001). When the cohort was limited to CY1 patients without other distant metastases, cN2-3 (p = 0.01), the prognostic nutritional index (PNI) < 40 (p = 0.02) and Type 4 (p = 0.03) were independent risk factors according to a multivariate analysis. The survivals of patients with cN2-3 or PNI < 40 after gastrectomy were equivalent to those with other distant metastases, as assessed by log-rank analyses.
The prognoses of CY1 gastric cancer patients with cN2-3 or PNI < 40 were poor, even after gastrectomy.
胃癌细胞阳性腹腔灌洗细胞学检查（CY1）被视为远处转移，归类为IV期。然而，CY1患者群体具有异质性，其预后差异很大。对CY1胃癌患者的预后因素进行了回顾性分析。
研究对象为2005年至2017年间我院收治的80例CY1胃癌患者。采用单因素和多因素分析方法分析预后因素。
手术方式为远端胃切除术30例，全胃切除术27例，分期腹腔镜检查10例，胃空肠吻合术8例，探查性剖腹术5例。36例患者出现其他远处转移。多因素分析显示，其他远处转移是总生存的最强独立危险因素（p < 0.0001）。当队列仅限于无其他远处转移的CY1患者时，多因素分析显示cN2-3（p = 0.01）、预后营养指数（PNI）< 40（p = 0.02）和4型（p = 0.03）是独立危险因素。通过对数秩分析评估，胃切除术后cN2-3或PNI < 40患者的生存率与有其他远处转移患者的生存率相当。
即使行胃切除术后，cN2-3或PNI < 40的CY1胃癌患者预后也较差。
