title: Clinicopathological analysis and prognostic significance of peritoneal  cytology in Chinese patients with advanced gastric cancer.
abstract: BACKGROUND
  The influence of peritoneal cytology on survival of patients with gastric cancer has not been consistent. This study was to identify risk factors for positive peritoneal cytology and to evaluate the predictive value of positive cytology among Chinese patients with advanced gastric cancer.
  
  
  METHODS
  The study included 139 patients with gastric cancer macroscopically invading the serosa, who underwent gastrectomy and intra-operative peritoneal cytological examination. In these patients, the relationship between cytological positivity and various clinicopathological features was analysed, and survival analysis was performed to identify independent prognostic factors of significance.
  
  
  RESULTS
  Thirty-eight (27.3%) of 139 patients had positive peritoneal cytology. Although tumour size, lymphovascular invasion, depth of tumour invasion, lymph node metastasis and peritoneal metastasis were correlated with positive cytology, multivariate analysis revealed the depth of tumour invasion and peritoneal metastasis as the independent features affecting the cytology. Patients with a positive cytology result were confirmed to have a greater risk for recurrence in the pattern of peritoneal carcinomatosis and a significant inferior prognosis. Multivariate analysis indicated that positive peritoneal cytology was an independent prognostic factor among the curatively resected patients with advanced gastric cancer and was the prognostic factor most predictive of death for these patients (risk ratio = 2.74).
  
  
  CONCLUSIONS
  Positive peritoneal cytology correlated with advanced features of gastric cancer. It is an independent poor prognostic factor, and it may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer.
authors.affiliation: Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
authors.forename: Cheng-Gang
authors.initials: CG
authors.lastname: Jiang
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.forename: Zhen-Ning
authors.initials: ZN
authors.lastname: Wang
authors.forename: Zhe
authors.initials: Z
authors.lastname: Sun
authors.forename: Fu-Nan
authors.initials: FN
authors.lastname: Liu
authors.forename: Miao
authors.initials: M
authors.lastname: Yu
authors.forename: Hui-Mian
authors.initials: HM
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010537:Peritoneum / Q000166:cytology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012704:Serous Membrane / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis