Background
Methods
Ethics approval and consent
Patients
Patient inclusion criteria
Classification of peritoneal seeding
Follow-up
Statistical methods
Results
Patient demographics
Clinical pathological data | Fewer than 18.5 (n = 167 cases) | Between 18.5–23 (n = 232 cases) | Greater than 23 (n = 119 cases) |
p value | ||||
---|---|---|---|---|---|---|---|---|
Cases | % | Cases | % | Cases | % | |||
Age (years) | Mean | 52.6 | 52.9 | 53.3 | – | |||
Range | 20–85 | 19–85 | 29–84 | |||||
Sex | Male | 95 | 56.9 | 122 | 52.6 | 72 | 60.5 | |
Female | 72 | 43.1 | 110 | 47.4 | 47 | 39.5 | 0.347 | |
Tumor location | Gastric cardia | 40 | 24.0 | 47 | 20.3 | 31 | 26.1 | |
Middle | 26 | 15.6 | 47 | 20.3 | 32 | 26.9 | ||
Antrum | 63 | 37.7 | 92 | 39.7 | 36 | 30.3 | ||
Total stomach | 38 | 22.8 | 46 | 19.8 | 20 | 16.8 | 0.181 | |
Surgery | Gastrectomy | 90 | 53.9 | 165 | 71.1 | 75 | 63.0 | |
No gastrectomy | 77 | 46.1 | 67 | 28.9 | 44 | 37.0 | 0.002 | |
Tumor size | <5 cm | 50 | 29.9 | 91 | 39.2 | 47 | 39.5 | |
≥5 and <10 cm | 83 | 49.7 | 104 | 44.8 | 56 | 47.1 | ||
≥10 cm | 34 | 20.4 | 37 | 15.9 | 16 | 13.4 | 0.249 | |
Serum CEA level | <5 ng/ml | 104 | 67.5 | 165 | 73.7 | 80 | 70.8 | |
≥5 ng/ml | 50 | 32.5 | 59 | 26.3 | 33 | 29.2 | 0.433 | |
CA19-9 level | <35 U/ml | 91 | 59.9 | 151 | 69.3 | 72 | 63.7 | |
≥35U/ml | 61 | 40.1 | 67 | 30.7 | 41 | 36.3 | 0.166 | |
Seeding gradea
| P1 | 28 | 16.8 | 66 | 28.4 | 42 | 35.3 | |
P2 | 44 | 26.3 | 72 | 31.0 | 33 | 27.7 | ||
P3 | 95 | 56.9 | 94 | 40.5 | 44 | 37.0 | 0.001 | |
Multi-site metastasis | Without | 97 | 58.1 | 181 | 78.0 | 81 | 68.1 | |
With | 70 | 41.9 | 51 | 22.0 | 38 | 31.9 | < 0.001 | |
Chemotherapy | Without | 77 | 46.1 | 68 | 29.3 | 36 | 30.3 | |
With | 90 | 53.9 | 164 | 70.7 | 83 | 69.7 | 0.001 |
Univariate analyses of the prognosis of this group of gastric cancer patients with peritoneal dissemination
Variables |
n
| 1-year survival rate (%) | Median survival (months) |
p value |
---|---|---|---|---|
All 518 gastric cancer patients with peritoneal dissemination | ||||
Palliative gastrectomy | <0.001 | |||
With | 330 | 19 | 7.33 | |
Without | 188 | 31 | 16.13 | |
Tumor size | <0.001 | |||
<5 cm | 188 | 31 | 17.30 | |
5 and <10 cm | 243 | 26 | 11.00 | |
>10 cm | 87 | 18 | 9.30 | |
Tumor location | 0.011 | |||
Upper | 118 | 23 | 12.00 | |
Middle | 105 | 30 | 15.60 | |
Lower | 191 | 39 | 13.33 | |
Total | 104 | 20 | 8.97 | |
Peritoneal seeding grade | <0.001 | |||
P1 | 136 | 34 | 18.67 | |
P2 | 149 | 31 | 15.48 | |
P3 | 233 | 19 | 8.97 | |
Ascite | 0.001 | |||
With | 207 | 20 | 9.87 | |
Without | 311 | 31 | 14.27 | |
Serum CEA level (ng/ml) | 0.002 | |||
Normal | 349 | 29 | 14.03 | |
Elevated | 142 | 20 | 9.33 | |
Serum CA19-9 level (U/ml) | 0.033 | |||
Normal | 314 | 29 | 13.53 | |
Elevated | 169 | 22 | 11.27 | |
Palliative chemotherapy | <0.001 | |||
Yes | 337 | 35 | 17.40 | |
No | 181 | 9 | 6.90 | |
BMI group (kg/m2) | <0.001 | |||
<18.5 | 167 | 15 | 8.17 | |
18.5–23 | 232 | 35 | 18.67 | |
>23 | 119 | 25 | 11.87 |
BMI value was an independent prognostic factor of gastric cancer patients with peritoneal dissemination by multivariate analyses
Variable | HR | 95% CI |
p value |
---|---|---|---|
OS in gastric cancer patients | |||
Palliative gastrectomy (Gastrectomy vs. without gastrectomy)a
| 0.689 | 0.540–0.879 | 0.003 |
Tumor size (<5, ≥5, and <10 vs. ≥10 cm) | 1.176 | 0.999–1.383 | 0.051 |
Tumor location (Upper, middle, and lower vs. total) | 1.080 | 0.962–1.213 | 0.192 |
Ascite (With vs. without) | 1.026 | 0.817–1.288 | 0.827 |
Peritoneal seeding grade (P1 and P2 vs. P3) | 1.298 | 1.124–1.500 | < 0.001 |
Serum CEA Level (Normal vs. elevated) | 1.424 | 1.120–1.810 | 0.004 |
Serum CA19-9 Level (Normal vs. elevated) | 1.133 | 0.900–1.424 | 0.287 |
Palliative chemotherapy (With vs. without) | 0.399 | 0.314–0.506 | < 0.001 |
BMI group (<18.5 and 18.5–23 vs. >23) | 0.812 | 0.686–0.962 | 0.016 |
Univariate analyses and multivariate analysis of the prognosis of gastric cancer patients with peritoneal dissemination without palliative chemotherapy
Variable | HR | 95% CI |
p value |
---|---|---|---|
OS in gastric cancer patients | |||
Palliative gastrectomy (Gastrectomy vs. without gastrectomy)a
| 0.772 | 0.516–1.154 | 0.207 |
Tumor size (<5, ≥5, and <10 vs. ≥10 cm) | 1.016 | 0.771–1.339 | 0.910 |
Tumor location (Upper, middle, and lower vs. total) | 1.314 | 1.070–1.614 | 0.009 |
Ascite (With vs. without) | 0.969 | 0.653–1.438 | 0.877 |
Peritoneal seeding grade (P1 and P2 vs. P3) | 1.507 | 1.178–1.928 | 0.001 |
Serum CEA Level (Normal vs. elevated) | 1.356 | 0.915–2.011 | 0.129 |
Serum CA19-9 Level (Normal vs. elevated) | 1.384 | 0.943–2.031 | 0.097 |
BMI group (<18.5 and 18.5–23 vs. >23) | 0.871 | 0.654–1.161 | 0.346 |
Univariate analyses and multivariate analysis of the prognoses of gastric cancer patients with peritoneal dissemination with palliative chemotherapy
Variable | HR | 95% CI |
p value |
---|---|---|---|
OS in gastric cancer patients | |||
Palliative gastrectomy (Gastrectomy vs. without gastrectomy)a
| 0.652 | 0.477–0.893 | 0.008 |
Tumor size (<5, ≥5, and <10 vs. ≥10 cm) | 1.265 | 1.027–1.559 | 0.027 |
Tumor location (Upper, middle, and lower vs. total) | 0.972 | 0.844–1.118 | 0.689 |
Peritoneal seeding grade (P1 and P2 vs. P3) | 1.172 | 0.982–1.398 | 0.079 |
Serum CEA level (Normal vs. elevated) | 1.413 | 1.045–1.912 | 0.025 |
BMI group (<18.5 and 18.5–23 vs. >23) | 0.783 | 0.636–0.964 | 0.021 |