J Korean Surg Soc.  2012 Apr;82(4):219-226. 10.4174/jkss.2012.82.4.219.

Prognostic significance of computed tomography defined ascites in advanced gastric cancer

• Cheong JC
• Choi WH
• Kim DJ
• Park JH
• Cho SJ
• Choi CS
• Kim JS

• KMID: 1820069
• DOI: http://doi.org/10.4174/jkss.2012.82.4.219

Abstract

PURPOSE
The aim of this study was to investigate the clinicopathologic features and prognosis in patients with computed tomography (CT) findings of ascites, with a focus on the correlation with peritoneal carcinomatosis.
METHODS
This study included a total of 157 patients who underwent surgery for advanced gastric cancer from 2003 to 2008 at the Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea, which were analyzed retrospectively.
RESULTS
Fourteen patients (8.9%) presented ascites on their CT scan. Among them, 10 patients had peritoneal carcinomatosis, and showed significant difference with CT ascites positive group in the incidence of peritoneal carcinomatosis. The presence of CT ascites was significantly correlated with pathologic T stage, tumor size, histologic type, CT T and N stages, CT peritoneal nodularity and curability of surgery, statistically. The prognosis of CT ascites positive group was much poorer in the total advanced gastric cancer patients (P < 0.001), as well as in patients with pathologic T4 (P = 0.002). Also in patients without peritoneal carcinomatosis, CT ascites positive subgroup tended to have a worse prognosis than CT ascites negative subgroup (P = 0.086). Tumor size, CT T and N stages and the presence of CT peritoneal nodularity and ascites influenced the prognosis significantly; among which, if a tumor size larger than 5 cm, CT T4 stage and the presence of CT ascites were identified as independent prognostic factors.
CONCLUSION
The presence of ascites was closely associated with peritoneal metastasis, and was the most significant independent prognostic factor in advanced gastric cancer in the present study.

Keyword

Ascites; Computed tomography; Stomach; Adenocarcinoma; Prognosis

MeSH Terms

Adenocarcinoma
Ascites
Carcinoma
Heart
Humans
Incidence
Korea
Neoplasm Metastasis
Prognosis
Stomach
Stomach Neoplasms

Figure

• 

  Fig. 1 (A) Cumulative overall survival of 157 advanced gastric cancer patients according to the status of computed tomography (CT) ascites (P < 0.001) (log rank test). (B) Cumulative survival of 63 patients with pathologic T4 (tumor invaded serosal surface or stomach or extended to adjacent organ across the serosal layer) in relation to the presence of CT ascites (P = 0.002) (log rank test). Group CT ascites (+), patients who had ascites regardless of the amount on their CT (n = 14); Group CT ascites (-), patients who did not showed ascites on CT (n = 143).

• 

  Fig. 2 Comparison of cumulative survival stratified by the status of peritoneal carcinomatosis and the presence of computed tomography (CT) ascites. Subgroup A, CT ascites (+) patients with peritoneal carcinomatosis (n = 10); Subgroup B, CT ascites (-) patients with peritoneal carcinomatosis (n = 11); Subgroup C, CT ascites (+) patients without peritoneal carcinomatosis (n = 4); Subgroup D, CT ascites (-) patients without peritoneal carcinomatosis (n = 132). Subgroups A vs. B (P = 0.388); subgroups B vs. C (P = 0.684), subgroups C vs. D (P = 0.086).

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