Prognostic impact of positive peritoneal cytology (POPEC) in gastric cancer: Multi-centre European retrospective cohort study
<h2>Abstract</h2><h3>Objective</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusion</h3> 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. <h3>Synopsis</h3> 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.
Authors
- James Halle‐Smith (ORCID: https://orcid.org/0000-0001-6241-5680)
- Guowei Kim (ORCID: https://orcid.org/0000-0002-4705-6808)
- Manuel Pera (ORCID: https://orcid.org/0000-0002-9449-1810)
- Mariagiulia Dal Cero (ORCID: https://orcid.org/0000-0002-0558-2244)
- Mark I. van Berge Henegouwen (ORCID: https://orcid.org/0000-0001-8689-3134)
- Guillaume Piessen (ORCID: https://orcid.org/0000-0001-8243-8310)
- Kerstin Neuschütz
- Aileen Pang
- Andrea Cossu (ORCID: https://orcid.org/0000-0003-4086-8640)
- Peter Grimminger (ORCID: https://orcid.org/0000-0002-1859-9213)
- Sheraz R. Markar (ORCID: https://orcid.org/0000-0001-8650-2017)
- Swathikan Chidambaram (ORCID: https://orcid.org/0000-0002-4009-3243)
- Marcel André Schneider (ORCID: https://orcid.org/0000-0002-6723-8879)
- John V. Reynolds (ORCID: https://orcid.org/0000-0002-5501-9521)
- Asim Shabbir (ORCID: https://orcid.org/0000-0002-2490-6478)
- Suzanne Sarah Gisbertz (ORCID: https://orcid.org/0000-0001-9655-7601)
- Khalid Shamiyah
- Christian Alexander Gutschow (ORCID: https://orcid.org/0000-0001-6171-4427)
- Frederik Klevebro
- Jakob Hedberg (ORCID: https://orcid.org/0000-0003-1308-4592)
- Richard van Hillegersberg
- J. Saunders (ORCID: https://orcid.org/0000-0003-0383-3676)
- Kammy Keywani (ORCID: https://orcid.org/0000-0002-4027-8715)
- Ewen A. Griffiths (ORCID: https://orcid.org/0000-0001-6630-3547)
- Nick Maynard (ORCID: https://orcid.org/0000-0001-7897-8162)
- Ellen A. Boyle (ORCID: https://orcid.org/0000-0002-5896-9610)
- Jessie Andrea Elliott (ORCID: https://orcid.org/0000-0003-4673-0386)
- Javed Sultan (ORCID: https://orcid.org/0000-0001-5343-3641)
- Magnus Nilsson (ORCID: https://orcid.org/0000-0002-6215-8132)
- Vanessa Peronace
- Jelle P. H. Ruurda (ORCID: https://orcid.org/0000-0001-6584-1677)
- Lana Fourie (ORCID: https://orcid.org/0000-0003-4291-4700)
- Jimmy Bok Yan So (ORCID: https://orcid.org/0000-0002-9772-7905)
- Amina Youcef
- Daryl Kai Ann Chia (ORCID: https://orcid.org/0000-0001-9936-1225)
- Sivesh Kathir Kamarajah (ORCID: https://orcid.org/0000-0002-2748-0011)
- Lianne Triemstra (ORCID: https://orcid.org/0000-0002-7057-0274)
- Eren Uzun
- Khalid Bhatti (ORCID: https://orcid.org/0000-0002-3530-1730)
- Ricardo Calef
- Candy Yap
- Ricardo Rosati
- Richard J Owen (ORCID: https://orcid.org/0000-0002-9713-7550)
- Clarisse Eveno
- M Penninger Josef
- Tim Bagnell
Institutions
- Uppsala University (SE)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Karolinska University Hospital (SE)
- National University of Singapore (SG)
- University of Basel (CH)
- Johannes Gutenberg University Mainz (DE)
- Queen Elizabeth Hospital Birmingham (GB)
- Churchill Hospital (GB)
- University of Manchester (GB)
- San Raffaele University of Rome (IT)
- University Medical Center Utrecht (NL)
- University of Oxford (GB)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- University Hospital of Zurich (CH)
- Ludwig Cancer Research (GB)
- St Mary's Hospital (GB)
- Salford Royal Hospital (GB)
- Hospital Del Mar (ES)
- Oxford University Hospitals NHS Trust (GB)
- Amsterdam University Medical Centers (NL)
- St. James's Hospital (IE)
- Hôpital Claude Huriez (FR)
- St. Mary's Hospital (GB)
- Cancer Center Amsterdam (NL)
- Imperial College London (GB)
- University of Birmingham (GB)
- University of Amsterdam (NL)
Publication Details
- Journal
- Surgical Oncology Insight
- Published
- 2025-05-08
- DOI
- https://doi.org/10.1016/j.soi.2025.100145
- Citations
- 2
- Primary Topic
- Gastric Cancer Management and Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 3.04