title: Prognostic Significance of Molecular Analysis of Peritoneal Fluid for Patients with Gastric Cancer: A Meta-Analysis.
abstract: BACKGROUND
  Accurately distinguishing serosal invasion in patients with gastric cancer (GC) prior to surgery can be difficult. Molecular analysis of peritoneal fluid (MAPF) for free cancer cells with higher sensitivity than other methods; however, its prognostic value for GC remains controversial, precluding its application in clinical practice.
  
  
  METHODS
  PubMed, EMBASE and other databases were systematically searched. Thirty-one studies were eligible for the meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled for overall survival (OS), disease-free survival (DFS) and peritoneal recurrence-free survival (PRF).
  
  
  RESULTS
  The current meta-analysis focused on patients with GC and negative cytological diagnoses. The results showed that positive MAPF status (MAPF+) led to poorer prognoses for OS (HR 2.59, 95% CI 1.99-3.37), DFS (HR 4.92, 95% CI 3.28-7.37) and PRF (HR 2.81, 95% CI 2.12-3.72) compared with negative MAPF status (MAPF-). Moreover, among the patients with GC who received curative treatment, the MAPF+ patients had poorer prognoses for OS (HR 3.27, 95% CI 2.49-4.29), DFS (HR 3.90, 95% CI 2.74-5.57) and PRF (HR 5.45, 95% CI 3.70-8.03). A meta-analysis of multivariate-adjusted HRs demonstrated that MAPF+ status was an independent prognostic factor for patients with GC who underwent curative treatment (OS: HR 2.19, 95% CI 1.47-3.28; PRF: HR 3.44, 95% CI 2.01-5.87). Using the identical target genes (CEA, CEA/CK20) as molecular markers, the patients with GC who were MAPF+ had significantly worse prognoses for OS (CEA: HR 3.03, 95% CI 2.29-4.01; CEA/CK20: HR 4.24, 95% CI 2.42-7.40), DFS (CEA: HR 3.99, 95% CI 2.24-7.12; CEA/CK20: HR 4.31, 95% CI 1.49-2.48) and PRF (CEA: HR 4.45, 95% CI 2.72-7.31; CEA/CK20: HR 6.46, 95% CI 3.62-11.55) than the patients who were MAPF-.
  
  
  CONCLUSIONS
  The above results demonstrate that MAPF could be a prognostic indicator for patients with GC who have a negative cytological diagnosis and/or are receiving curative treatment. MAPF could provide clinicians with additional prognostic information that could aid in developing individualized treatment plans prior to surgery. The widely used target genes CEA, CEA/CK20 were confirmed to be valuable MAPF markers for predicting the prognosis of GC.
authors.affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Deng
authors.affiliation: Department of Abdominal Cancer, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, 610041, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors.forename: Junchao
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors.forename: Renwei
authors.initials: R
authors.lastname: Hu
authors.affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors.forename: Chengwei
authors.initials: C
authors.lastname: Tang
mesh_terms: D001202:Ascitic Fluid / Q000737:chemistry*; D014408:Biomarkers, Tumor / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000032:analysis; D006801:Humans; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000401:mortality; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen