Prognostic Factors in Advanced Gastric Cancer with Peritoneal Carcinomatosis

Ryu, Keun Won; Mok, Young Jae; Kim, Seung Joo; Kim, Chong Suk

Abstract

PURPOSE: Peritoneal carcinomatosis is a dismal prognostic factor and is frequently encountered during initial exploration in gastric-cancer patients, but there are no effective therapeutic modalities. Thus, we investigated the prognostic factors in gastric-cancer patients with peritoneal carcinomatosis and evaluated the usefulness of intraperitoneal (IP) chemotherapy as a treatment modality in such patients. METHODS: From 1992 to 1997 in Korea University Guro Hospital, 105 patients revealed at initial exploration peritoneal carcinomatosis due to gastric cancer. We excluded two patients who died due to postoperative complications and 10 patients who were lost during follow up. Prognostic factors, including IP che motherapy, were analyzed by using univariate and multivariate methods for the remaining 93 cases.
RESULTS
The median survival time of the 93 patients was 7.86 months, and the frequency of peritoneal carcinomatosis at initial exploration was 11.6%. On univariate analysis, sex, tumor depth, degree of peritoneal seeding, presence of hepatic metastasis, operative method, and systemic chemotherapy were significant prognostic factors. However, IP chemotherapy was not a significant prognostic factor. On multivariate analysis, only the degree of peritoneal seeding and the presence of hepatic metastasis were significant prognostic factors (p<0.05). CONCLUSIONS: The most important prognostic factors in peritoneal carcinomatosis in gastric-cancer patients are the degree of peritoneal seeding and the presence of hepatic metastasis. However, operative resection of the primary tumor may prolong survival and improve the quality of life. Thus, a resection is recommended when possible.