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Preoperative predictive factors for positive peritoneal cytology results in patients with pancreatic ductal adenocarcinomas: a retrospective study

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Abstract

Background

The clinical importance of positive peritoneal cytology results in patients with pancreatic ductal adenocarcinomas remains controversial. We evaluated the prognosis of these patients and the predictive preoperative risk factors for positive peritoneal cytology results.

Methods

We retrospectively reviewed patients who underwent curative-intent surgery at our institution between May 2010 and June 2020. Preoperative risk factors for positive peritoneal cytology results were identified using logistic regression analysis. A scoring model was constructed using the total number of significant independent predictors for positive peritoneal cytology results.

Results

Of 233 patients, 18 (7.7%) had positive peritoneal cytology results. The recurrence-free survival and cancer-specific survival were markedly worse in patients with positive peritoneal cytology results than in those with negative peritoneal cytology results (recurrence-free survival: 6.0 months vs. 16.6 months, p = 0.050; cancer-specific survival: 19.4 months vs. 47.5 months, p = 0.034). Tumor location (odds ratio: 3.760, 95% confidence interval: 1.099–11.818, p = 0.023), tumor size > 25 mm (odds ratio: 3.410, 95% confidence interval: 1.031–11.277, p = 0.046), preoperative serosal invasion (odds ratio: 5.193, 95% confidence interval: 1.099–24.531, p = 0.038), and preoperative carcinoembryonic antigen level > 5.6 ng/mL (odds ratio: 3.816, 95% confidence interval: 1.248–10.667, p = 0.019) were identified as significant independent predictive factors. Our predictive model’s optimal cutoff and positive predictive values for positive peritoneal cytology results were 3 and 27.9%, respectively.

Conclusions

The indications for curative-intent surgery should be considered carefully in patients with high-risk factors for positive peritoneal cytology results.

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References

  1. Aletti GD, Gallenberg MM, Cliby WA et al (2007) Current management strategies for ovarian cancer. Mayo Clin Proc 82:751–770

    Article  PubMed  Google Scholar 

  2. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma:3rd English edition. Gastric Cancer. 14:101–112

    Article  Google Scholar 

  3. Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 15:1028–1061

    Article  PubMed  Google Scholar 

  4. Japan Pancreas Society (2017) Japan Pancreas Society: classification of pancreatic carcinoma 4th English edition. Kanehara, Tokyo

    Google Scholar 

  5. Yachida S, Fukushima N, Sakamoto M et al (2002) Implications of peritoneal washing cytology in patients with potentially resectable pancreatic cancer. Br J Surg 89:573–578

    Article  CAS  PubMed  Google Scholar 

  6. Meszoely IM, Lee JS, Watson JC et al (2004) Peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreas. Am Surg 70:208–213

    Article  PubMed  Google Scholar 

  7. Yoshioka R, Saiura A, Koga R et al (2012) The implications of positive peritoneal lavage cytology in potentially resectable pancreatic cancer. World J Surg 36:2187–2191

    Article  PubMed  Google Scholar 

  8. Hoshimoto S, Hishinuma S, Shirakawa H et al (2017) Prognostic significance of intraoperative peritoneal washing cytology for patients with potentially resectable pancreatic ductal adenocarcinoma. Pancreatology 17:109–114

    Article  PubMed  Google Scholar 

  9. Tsuchida H, Fujii T, Mizuma M et al (2019) Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: a nationwide, cancer registry-based study from the Japan Pancreas Society. Surgery 166:997–1003

    Article  PubMed  Google Scholar 

  10. Abe T, Ohuchida K, Endo S et al (2017) Clinical importance of intraoperative peritoneal cytology in patients with pancreatic cancer. Surgery 161:951–958

    Article  PubMed  Google Scholar 

  11. Satoi S, Murakami Y, Motoi F et al (2015) Reappraisal of peritoneal washing cytology in 984 patients with pancreatic ductal adenocarcinoma who underwent margin-negative resection. J Gastrointest Surg 19:6–14

    Article  PubMed  Google Scholar 

  12. Yamada S, Fujii T, Kanda M et al (2013) Value of peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg 100:1791–1796

    Article  CAS  PubMed  Google Scholar 

  13. Tanaka M, Mihaljevic AL, Probst P et al (2019) Meta-analysis of recurrence pattern after resection for pancreatic cancer. Br J Surg 106:1590–1601

    Article  CAS  PubMed  Google Scholar 

  14. Nomoto S, Nakao A, Kasai Y et al (1997) Peritoneal washing cytology combined with immunocytochemical staining and detecting mutant K-ras in pancreatic cancer: comparison of the sensitivity and availability of various methods. Pancreas 14:126–132

    Article  CAS  PubMed  Google Scholar 

  15. Igarashi T, Fukasawa M, Watanabe T et al (2023) Evaluating staging laparoscopy indications for pancreatic cancer based on resectability classification and treatment strategies for patients with positive peritoneal washing cytology. Ann Gastroenterol Surg. https://doi.org/10.1002/ags3.12719

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aoki S, Mizuma M, Hayashi H et al (2020) Prognostic impact of intraoperative peritoneal cytology after neoadjuvant therapy for potentially resectable pancreatic cancer. Pancreatology 20:1711–1717

    Article  CAS  PubMed  Google Scholar 

  17. Ariake K, Mizuma M, Motoi F et al (2021) Preceding systemic chemotherapy for patients with pancreatic ductal adenocarcinoma with positive peritoneal cytology provides survival benefit compared with up-front surgery. Ann Surg Oncol 28:6246–6254

    Article  PubMed  Google Scholar 

  18. Allen VB, Gurusamy KS, Takwoingi Y et al (2016) Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 7:CD009323

    PubMed  Google Scholar 

  19. Schnelldorfer T, Gagnon AI, Birkett RT et al (2014) Staging laparoscopy in pancreatic cancer: a potential role for advanced laparoscopic techniques. J Am Coll Surg 218:1201–1206

    Article  PubMed  Google Scholar 

  20. Sell NM, Fong ZV, Del Castillo CF et al (2018) Staging laparoscopy not only saves patients an incision, but may also help them live longer. Ann Surg Oncol 25:1009–1016

    Article  PubMed  Google Scholar 

  21. Satoi S, Yanagimoto H, Yamamoto T et al (2016) A clinical role of staging laparoscopy in patients with radiographically defined locally advanced pancreatic ductal adenocarcinoma. World J Surg Oncol 14:14

    Article  PubMed  PubMed Central  Google Scholar 

  22. Endo Y, Kitago M, Aiura K et al (2019) Efficacy and safety of preoperative 5-fluorouracil, cisplatin, and mitomycin C in combination with radiotherapy in patients with resectable and borderline resectable pancreatic cancer: a long-term follow-up study. World J Surg Oncol 17:145

    Article  PubMed  PubMed Central  Google Scholar 

  23. Uesaka K, Boku N, Fukutomi A et al (2016) Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 388:248–257

    Article  CAS  PubMed  Google Scholar 

  24. Yamada S, Takeda S, Fujii T et al (2007) Clinical implications of peritoneal cytology in potentially resectable pancreatic cancer: positive peritoneal cytology may not confer an adverse prognosis. Ann Surg 246:254–258

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kanda M, Kodera Y (2016) Molecular mechanisms of peritoneal dissemination in gastric cancer. World J Gastroenterol 22:6829–6840

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wu W, He J, Cameron JL et al (2014) The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol 21:2873–2881

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ito T, Sugiura T, Okamura Y et al (2017) The diagnostic advantage of EOB-MR imaging over CT in the detection of liver metastasis in patients with potentially resectable pancreatic cancer. Pancreatology 17:451–456

    Article  PubMed  Google Scholar 

  28. Ferrone CR, Haas B, Tang L et al (2006) The influence of positive peritoneal cytology on survival in patients with pancreatic adenocarcinoma. J Gastrointest Surg 10:1347–1353

    Article  PubMed  Google Scholar 

  29. Chiba K, Hata T, Mizuma M et al (2021) Impact of tumor-derived DNA testing in peritoneal lavage of pancreatic cancer patients with and without occult intra-abdominal metastases. Ann Surg Oncol 29:2685–2697

    Article  PubMed  Google Scholar 

  30. Suenaga M, Fujii T, Yamada S et al (2020) Peritoneal lavage tumor DNA as a novel biomarker for predicting peritoneal recurrence in pancreatic ductal adenocarcinoma. Ann Surg Oncol 28:2277–2286

    Article  PubMed  Google Scholar 

  31. Yonkus JA, Alva-Ruiz R, Abdelrahman AM et al (2021) Molecular peritoneal staging for pancreatic ductal adenocarcinoma using mutant KRAS droplet-digital polymerase chain reaction: results of a prospective clinical trial. J Am Coll Surg 233:73-80.e1

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Kazumasa Fukuda, a staff member of the Department of Surgery at Keio School of Medicine, for his help in preparing this article. We would like to thank Editage (www.editage.jp) for their English language editing services.

Funding

The authors declare no source of funding.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 160-8582, Japan

    Gaku Shimane, Yutaka Nakano, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yasushi Hasegawa & Yuko Kitagawa

  2. Department of Radiology, Dokkyo Medical University School of Medicine, 880 Kita-Kobayashi, Mibu, Tochigi, 321-0293, Japan

    Shigeyoshi Soga

  3. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-Ku, Tokyo, 160-8582, Japan

    Shigeo Okuda

  4. Department of Biostatistics, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Ryota Ishii

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  1. Gaku Shimane
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  2. Yutaka Nakano
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Correspondence to Minoru Kitago.

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Shimane, G., Nakano, Y., Kitago, M. et al. Preoperative predictive factors for positive peritoneal cytology results in patients with pancreatic ductal adenocarcinomas: a retrospective study. Int J Clin Oncol 29, 985–993 (2024). https://doi.org/10.1007/s10147-024-02523-1

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  • DOI: https://doi.org/10.1007/s10147-024-02523-1

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