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Gastric cancer with minimal peritoneal metastasis: is this a sign to give up or to treat more aggressively?

Department of Surgery II (Department of Gastroenterological Surgery), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya journal of medical science (Impact Factor: 0.8). 02/2013; 75(1-2):3-10.
Source: PubMed

ABSTRACT Peritoneal metastasis from gastric cancer is often undetectable by routine imaging studies. Even a microscopic metastasis detected only by cytologic examination of the peritoneal washes denotes a dismal prognosis, and surgery is ruled out as futile for patients who turn out to be cytology-positive by staging laparoscopy. On the other hand, recent developments in cancer chemotherapy have improved the outcome of the cytology-positive population to the point where a certain proportion of these patients survive for 5 years through a straightforward strategy of radical surgery followed by chemotherapy. Thus, there is certainly a role for surgeons in patients with minimal peritoneal metastasis, both in clinical practice and in clinical trials where multimodal treatment strategies including surgery are to be explored. Even in this category of patients, surgery in combination with various types of chemotherapy remains the only hope for a cure.

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    ABSTRACT: The present study is to evaluate the effect of methylated p16 on the progression in patients with gastric cancer (GC), and develop a useful biomarker for predicting patient's prognosis. Methylation status of p16 in GC, their corresponding para-cancerous histological normal tissues (PCHNTs), preoperative peritoneal washes (PPWs) and serum were assessed using real-time methylation specific-PCR (MSP). The frequency of p16 methylation was significantly higher in GC tissues (85.9%; 79/92) than that in paired PCHNTs (12.0%; 11/92) (P<0.0001). p16 methylation correlated closely with lymph node metastasis, peritoneal metastasis, TNM stage, et al (all P<0.05). Both frequency of p16 methylation in PPWs and serum were 79.7% (63/92). The Aζ value of the receiver-operator characteristic curve for methylated p16 was 0.899 for serum and PPWs, compared to that in GC tissues. The patients with elevated methylated p16 levels in tumor tissues had poorer disease-free survival (DFS) rates than those without (P=0.042). There is a narrow significant difference in median survival time of more than 30 months between patients with and without preoperatively detectable methylated p16 in serum (P=0.057). Methylated p16 in PPWs revealed no significant association with survival (P=0.129). Cox regression analysis showed that serum methylated p16 DNAs was an independent risk factor for GC patients, with a remarkable decrease in DFS 30 months after surgical resection of the gastric tumor. Serum methylated p16 DNAs might serve as a potential biomarker for the progression and a prognostic factor in gastric cancer patients.
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