title: Borrmann's macroscopic criteria and p-Smad2 expression are useful predictive prognostic markers for cytology-positive gastric cancer patients without overt peritoneal metastasis.
abstract: BACKGROUND
  All patients with peritoneal-free cancer cells (CY1) do not always develop a peritoneal recurrence (P1). The goal of this study was to identify characteristic features of peritoneal-free cancer cells that could develop into peritoneal recurrence.
  
  
  METHODS
  Of 1,474 patients, 91 were identified with CY1P0, and the remaining 1,383 with CY0P0. Immunohistochemical staining with anti-phosphorylated Smad 2 (p-Smad2) was performed on paraffin-embedded specimens from the 91 CY1P0 patients.
  
  
  RESULTS
  CY1 was significantly correlated with Borrmann's type-4 cancer, clinical T stage, and lymph node metastasis. CY1P0 patients with Borrmann's type-4 cancer more frequently develop peritoneal recurrence than do those with other types of tumors. The 5-year survival rate of patients with Borrmann's type-4 tumors was significantly (p = 0.023) low (6.3%) compared with that of patients with other types of tumors (27.7%). The prognosis for p-Smad2-positive patients was significantly poorer than that of p-Smad2-negative patients. In CY1 and/or P1 patients with Borrmann's type-4 tumors, no significant difference in prognosis was identified between those who had surgery and those who did not.
  
  
  CONCLUSIONS
  Activated Smad signaling might be associated with a high potential for peritoneal recurrence in CY1P0 patients. Borrmann's macroscopic criteria and p-Smad2 expression are useful markers for surgeons selecting advanced gastric cancer patients with CY1P0 for gastrectomy.
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Noda
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yashiro
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyokawa
authors.forename: Jyunya
authors.initials: J
authors.lastname: Morimoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Shinto
authors.forename: Kazuya
authors.initials: K
authors.lastname: Muguruma
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Sawada
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000556:secondary*; D010766:Phosphorylation; D011379:Prognosis; D051899:Smad2 Protein / Q000378:metabolism*; D013274:Stomach Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D015996:Survival Rate
chemical_list: C497782:SMAD2 protein, human; D051899:Smad2 Protein