Does Malignant Ascites Define Prognosis in Gastric Cancer with Peritoneal Spread? A Systematic Review and Meta-analysis.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2025-10-16 DOI:10.1007/s12029-025-01332-7

Francisco Cezar Aquino de Moraes, Luis Henrique Rios Moreira Rego, Gustavo Tadeu Freitas Uchôa Matheus, Clara Rocha Dantas, Ana Luiza Marçalo de Tolosa, Rommel Mario Rodríguez Burbano, Mario Hiroyuki Hirata

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引用次数: 0

Abstract

Background: Gastric cancer (GC) is the fifth most common cancer and a leading cause of cancer-related death. Peritoneal metastases occur in up to 25% of patients, with nearly half developing malignant ascites (MA), which arises from lymphatic obstruction, vascular permeability, and immune dysregulation. Median overall survival (OS) in this setting is poor (2-8 months). This systematic review and meta-analysis evaluate the prognostic impact of ascites in metastatic GC.

Materials and methods: PubMed, Embase, and Cochrane were searched for studies reporting OS in metastatic GC patients with and without ascites. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed and random-effects models in RStudio 4.2.3.

Results: Overall, 14 studies involving 2179 patients, with 1208 having ascites, were included in the analysis. Of these, 13 were retrospective studies and 1 was a prospective study. The presence of ascites was associated with a significantly worse prognosis compared to its absence (HR 1.8418; 95% CI 1.5657-2.1667; P < 0.001). Similarly, the comparison of massive type ascites with mild to moderate type shows a worse outcome for the higher grade of ascites (HR 1.8597; 95% CI 1.4633-2.3635; P < 0.001). Comparing no to moderate ascites vs massive ascites, the massive type also shows a significantly lower overall survival (HR 2.5114; 95% CI 1.5409-4.0931; P < 0.001).

Conclusions: This meta-analysis suggests that the presence of ascites and its grades are essential prognostic factors for metastatic gastric cancer, significantly worsening overall survival.

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恶性腹水决定胃癌腹膜扩散的预后吗？系统回顾和荟萃分析。

背景：胃癌是第五大常见癌症，也是癌症相关死亡的主要原因。高达25%的患者发生腹膜转移，其中近一半发展为恶性腹水（MA），这是由淋巴阻塞、血管通透性和免疫失调引起的。这种情况下的中位总生存期（OS）较差（2-8个月）。本系统综述和荟萃分析评估了转移性胃癌腹水对预后的影响。材料和方法：检索PubMed、Embase和Cochrane，以报告伴有或不伴有腹水的转移性胃癌患者发生OS的研究。使用RStudio 4.2.3中的固定效应和随机效应模型计算95%置信区间（ci）的风险比（hr）。结果：总的来说，14项研究涉及2179例患者，其中1208例有腹水，被纳入分析。其中13项为回顾性研究，1项为前瞻性研究。结论：本荟萃分析提示，腹水的存在及其分级是转移性胃癌的重要预后因素，会显著恶化总生存期。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.