Clinical risk factors associated with poor prognosis in gastric cancer patients with peritoneal metastasis

This retrospective study aimed to identify clinical risk factors associated with poor prognosis in elderly patients with gastric cancer with peritoneal metastasis. A total of 150 patients aged ≥65 years, treated at our institution between January 2019 and December 2023, were included. Eligible patients had histopathologically confirmed gastric adenocarcinoma with peritoneal metastasis verified by intraoperative findings, cytology, or imaging. Clinical, pathological, and laboratory data - including peritoneal implantation stage, ascites grade, Eastern Cooperative Oncology Group performance status, serum albumin, hemoglobin, neutrophil-to-lymphocyte ratio, and treatment modalities - were collected and analyzed. Survival outcomes were evaluated using Kaplan-Meier and Cox proportional-hazards regression analyses. The median overall survival was 8.3 months. Univariate and multivariate analyses identified advanced peritoneal implantation stage (P2-P3), higher ascites grade (moderate-massive), Eastern Cooperative Oncology Group ≥2, hypoalbuminemia (<35 g/L), and elevated neutrophil-to-lymphocyte ratio (≥3) as independent predictors of poor overall survival (P < .05). By contrast, systemic chemotherapy and palliative surgery were independently associated with improved survival. These findings indicate that both tumor burden-related and host condition-related parameters significantly affect prognosis. Comprehensive assessment incorporating peritoneal stage, ascites grade, functional status, and inflammatory markers may facilitate individualized therapeutic strategies and prognostic stratification in elderly patients with gastric cancer with peritoneal metastasis.