|
|
Back to 2014 Annual Meeting Abstracts
Reappraisal of Peritoneal Cytology in 984 Patients With Pancreatic Cancer Who Underwent Curative Resection
Sohei Satoi*1,8, Fuyuhiko Motoi2,8, Kenichiro Uemura3,8, Manabu Kawai4,8, Masanao Kurata5,8, Masayuki Sho6,8, Ippei Matsumoto7,8, Hiroaki Yanagimoto1,8, Michiaki Unno2,8, Hiroki Yamaue4,8, Goro Honda5,8, Yoshiyuki Nakajima6,8, Makoto Shinzeki7,8, a-Hon Kwon1,8, Yoshiaki Murakami3,8
1Department of Surgery, Kansai Medical University, Hirakata, Japan; 2Department of Surgery, Tohoku University, Sendai, Japan; 3Department of Surgery, Hiroshima University, Hiroshima, Japan; 4Second Department of Surgery, Wakayama Medical University, Wakayama, Japan; 5Department of Surgery, Komagome Hospital, Tokyo, Japan; 6Department of Surgery, Nara Medical University, Nara, Japan; 7Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; 8Multicenter Study Group of Pancreatobiliary Surgery, Japan, Japan
Introduction. Positive peritoneal washing cytology (CY) status in patients with resectable pancreatic cancer is defined as M1 disease in the American Joint Committee on Cancer. Although some articles have shown that there was no significant difference in overall survival curve between positive and negative CY in patients who underwent surgical resection, the number of patients with positive CY included retrospectively were a small population of 10-20 patients only. We reappraised the clinical value of peritoneal washing cytology in 984 pancreatic cancer patients with curative surgical intent.
Patients. We collected the clinical data of 984 patients with pancreatic cancer who underwent curative resection between 2001 and 2011 at 7 high-volume surgical institutions in Japan. There were 69 patients (7%) with positive CY (CY+ group), and 915 patients with negative CY (CY- group). Clinico-pathological data and survival curve were compared between the two groups, and multivariate analysis was performed to find prognostic factors. All surviving patients were followed up for at least 1 year.
Results. There were significant correlations between CY+ and high level of pre- and post-operative CA19-9, high rate of pancreatic body and tail cancer, large tumor, positive lymph node metastasis, high lymph node ratio, and low rate of R0 resection.
Overall survival curve of CY+ was significantly worse than that of CY- (16 months vs. 25 months, median survival tim;, 6% vs. 37% 3-year survival rate, p<0.001). A similar result was found upon comparison of disease-free survival (DFS) (8.8 months vs. 13.8 months, median DFS time; 5% vs. 25%, 3-year DFS rate, p<0.001). Multivariate analysis showed that CY-, CA19-9<115IU/l, resectable disease, R0 resection, negative lymph node metastasis, tumor differentiation, and post-operative adjuvant therapy were significantly independent prognostic factors. The CY+ group had a significantly higher rate of peritoneal metastasis as a primary site of recurrence, relative to the CY- group (48% vs 21%, p<0.001). Performance of gemcitabine or S-1-based adjuvant chemotherapy did not give a favorable survival outcome in patients with CY+. Multivariate analysis in the CY+ group indicated that the development of peritoneal metastasis only was independently associated with worse prognosis.
Conclusion. This study provides marginal support to the assumed benefits of curative resection for patients with CY+, and the development of a new strategy to prevent peritoneal metastasis during the post-operative period will be required for obtaining long-term survivors.
Back to 2014 Annual Meeting Abstracts
|
