Lack of prognostic significance of conventional peritoneal cytology in colorectal and gastric cancers: Results of EVOCAPE 2 multicentre prospective study

• Published in: European journal of surgical oncology 2013-07, Vol.39 (7), p.707-714
• Main Authors: Cotte, E, Peyrat, P, Piaton, E, Chapuis, F, Rivoire, M, Glehen, O, Arvieux, C, Mabrut, J.-Y, Chipponi, J, Gilly, F.-N
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Colorectal cancer; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Confidence Intervals; Cytodiagnosis; Cytology; Disease-Free Survival; Female; France; Gastric cancer; Hematology, Oncology and Palliative Medicine; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Neoplastic Cells, Circulating - pathology; Peritoneal carcinomatosis; Peritoneal Lavage; Peritoneum - cytology; Peritoneum - pathology; Predictive Value of Tests; Prognosis; Prognostic; Proportional Hazards Models; Prospective Studies; Statistics, Nonparametric; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Survival Analysis; Time Factors; Young Adult
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2013.03.021

Abstract Aim In digestive cancers, the prognostic significance of intraperitoneal free cancer cells remains unclear (IPCC). The main objective of this study was to assess the prognostic significance of IPCC in colorectal and gastric adenocarcinoma. The secondary objectives were to evaluate the predictive significance of IPCC for the development of peritoneal carcinomatosis (PC) and to evaluate the prevalence of synchronous PC and IPCC. Methods This was a prospective multicentre study. All patients undergoing surgery for a digestive tract cancer had peritoneal cytology taken. Patients with gastric and colorectal cancer with no residual tumour after surgery and no evidence of PC were followed-up for 2 years. The primary end point was overall survival. Results Between 2002 and 2007, 1364 patients were enrolled and 956 were followed-up over 2 years. Prevalence of IPCC was 5.7% in colon cancer, 0.6% in rectal cancer and 19.5% in gastric cancer. The overall 2-year survival rate for patients with IPCC was 34.7% versus 86.8% for patients with negative cytology ( p < 0.0001). By multivariate analysis, IPCC was not an independent prognostic factor. No relationship between cytology and recurrence was found. Conclusion The presence of IPCC was not an independent prognostic and didn't add any additional prognostic information to the usual prognostic factors related to the tumour (pTNM and differentiation). Moreover the presence of IPCC detected with this method didn't appear to predict development of PC. Peritoneal cytology using conventional staining doesn't seem to be a useful tool for the staging of colorectal and gastric cancers.