Prognostic impact of positive peritoneal cytology (POPEC) in gastric cancer: Multi-centre European retrospective cohort study

IF 1

Surgical Oncology Insight Pub Date : 2025-09-01 Epub Date: 2025-05-08 DOI:10.1016/j.soi.2025.100145

Richard Owen , Swathikan Chidambaram , Khalid Shamiyah , Jessie A Elliott , Jakob Hedberg , Sivesh Kamarajah , Frederik Klevebro , Marcel Andre Schneider , Lana Fourie , Christian Gutschow , Magnus Nilsson , Ewen Griffiths , Ricardo Rosati , Javed Sultan , Manuel Pera , Peter Grimminger , Guillaume Piessen , Clarisse Eveno , Jelle Ruurda , Richard van Hillegersberg , John Saunders

{"title":"Prognostic impact of positive peritoneal cytology (POPEC) in gastric cancer: Multi-centre European retrospective cohort study","authors":"Richard Owen , Swathikan Chidambaram , Khalid Shamiyah , Jessie A Elliott , Jakob Hedberg , Sivesh Kamarajah , Frederik Klevebro , Marcel Andre Schneider , Lana Fourie , Christian Gutschow , Magnus Nilsson , Ewen Griffiths , Ricardo Rosati , Javed Sultan , Manuel Pera , Peter Grimminger , Guillaume Piessen , Clarisse Eveno , Jelle Ruurda , Richard van Hillegersberg , John Saunders","doi":"10.1016/j.soi.2025.100145","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Positive peritoneal cytology is traditionally viewed as representative of metastatic disease and a poor prognostic factor. The objective of this multi-center study was to define the prognostic role of peritoneal cytology in curative gastrectomy, evaluate international variation in cytology sampling, and assess the impact on positive peritoneal cytology yields.</div></div><div><h3>Methods</h3><div>This was a multi-center international retrospective cohort study of 16 tertiary gastric cancer centers. Adult patients who underwent peritoneal lavage cytology at staging laparoscopy and subsequent gastrectomy between 2009 and 2023 were included. The primary outcome measure was overall survival at five years. Multivariable Cox regression provided hazard ratios (HRs) with 95 % CIs, adjusted for relevant confounding factors.</div></div><div><h3>Results</h3><div>837 patients with no radiological or macroscopic M1 disease were included, with a mean age of 66 (IQR 58–73) and 71 % were male. Non-distal gastric cancer was most common (47 %), with 59 % and 43 % of tumors staged pT3/4 and pN2/3, respectively. 66 patients (7.9 %) had positive cytology. Positive cytology was not associated with overall survival in multivariable analysis, controlled for stage and neoadjuvant treatment (HR=1.0; 95 %CI 0.51–2.0). Higher T and N stages were associated with positive cytology (p < 0.001). The proportion of patients with positive cytology was variable, depending on how many quadrants were sampled.</div></div><div><h3>Conclusion</h3><div>Positive peritoneal cytology with otherwise M0 disease was not associated with decreased survival after curative intent gastrectomy in this study, meaning prospective study is needed. The technique of performing peritoneal washings influenced cytology yield and thus must be standardized in a much-needed prospective evaluation of peritoneal cytology.</div></div><div><h3>Synopsis</h3><div>The POPEC multicenter international retrospective cohort study included 837 patients receiving curative gastrectomy. This study showed the technique of performing peritoneal washings influenced cytology yield, however positive peritoneal cytology was not associated with decreased survival. Therefore, positive peritoneal cytology should not be considered an absolute contradiction to curatively intended gastrectomy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100145"},"PeriodicalIF":1.0000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Oncology Insight","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2950247025000246","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/8 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Positive peritoneal cytology is traditionally viewed as representative of metastatic disease and a poor prognostic factor. The objective of this multi-center study was to define the prognostic role of peritoneal cytology in curative gastrectomy, evaluate international variation in cytology sampling, and assess the impact on positive peritoneal cytology yields.

Methods

This was a multi-center international retrospective cohort study of 16 tertiary gastric cancer centers. Adult patients who underwent peritoneal lavage cytology at staging laparoscopy and subsequent gastrectomy between 2009 and 2023 were included. The primary outcome measure was overall survival at five years. Multivariable Cox regression provided hazard ratios (HRs) with 95 % CIs, adjusted for relevant confounding factors.

Results

837 patients with no radiological or macroscopic M1 disease were included, with a mean age of 66 (IQR 58–73) and 71 % were male. Non-distal gastric cancer was most common (47 %), with 59 % and 43 % of tumors staged pT3/4 and pN2/3, respectively. 66 patients (7.9 %) had positive cytology. Positive cytology was not associated with overall survival in multivariable analysis, controlled for stage and neoadjuvant treatment (HR=1.0; 95 %CI 0.51–2.0). Higher T and N stages were associated with positive cytology (p < 0.001). The proportion of patients with positive cytology was variable, depending on how many quadrants were sampled.

Conclusion

Positive peritoneal cytology with otherwise M0 disease was not associated with decreased survival after curative intent gastrectomy in this study, meaning prospective study is needed. The technique of performing peritoneal washings influenced cytology yield and thus must be standardized in a much-needed prospective evaluation of peritoneal cytology.

Synopsis

The POPEC multicenter international retrospective cohort study included 837 patients receiving curative gastrectomy. This study showed the technique of performing peritoneal washings influenced cytology yield, however positive peritoneal cytology was not associated with decreased survival. Therefore, positive peritoneal cytology should not be considered an absolute contradiction to curatively intended gastrectomy.

查看原文本刊更多论文

胃癌腹膜细胞学阳性（POPEC）对预后的影响：多中心欧洲回顾性队列研究

目的腹膜细胞学阳性传统上被认为是转移性疾病的代表和预后不良的因素。这项多中心研究的目的是确定腹膜细胞学在治疗性胃切除术中的预后作用，评估细胞学采样的国际差异，并评估对腹膜细胞学阳性率的影响。方法对16个三级胃癌中心进行多中心国际回顾性队列研究。纳入了2009年至2023年间在腹腔镜分期和随后的胃切除术中接受腹膜灌洗细胞学检查的成年患者。主要结局指标是5年总生存率。多变量Cox回归提供了95 % ci的风险比（hr），校正了相关混杂因素。结果837例患者无影像学或宏观M1病变，平均年龄66岁（IQR 58-73），男性71% %。非远端胃癌最常见（47 %），分别有59 %和43 %的肿瘤分期为pT3/4和pN2/3。66例（7.9 %）细胞学阳性。在多变量分析中，细胞学阳性与分期和新辅助治疗的总生存率无关(HR=1.0；95 %可信区间0.51 - -2.0)。较高的T和N分期与细胞学阳性相关（p <； 0.001）。细胞学阳性患者的比例是可变的，这取决于采样多少象限。结论本研究中，腹膜细胞学阳性伴M0疾病与治疗性胃切除术后生存率降低无关，需要前瞻性研究。进行腹膜冲洗的技术影响细胞学的产量，因此必须在腹膜细胞学的一个急需的前瞻性评估标准化。POPEC多中心国际回顾性队列研究包括837例接受治愈性胃切除术的患者。本研究显示，腹膜冲洗技术会影响细胞学检查结果，但腹膜细胞学检查结果阳性与生存率降低无关。因此，腹膜细胞学阳性不应被认为是与治疗性胃切除术的绝对矛盾。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Surgical Oncology Insight

自引率

0.00%

发文量