title: Localized pancreatic cancer with positive peritoneal cytology as a sole manifestation of metastatic disease: a single-institution experience.
abstract: BACKGROUND
  Pancreatic cancer patients with positive peritoneal cytology (PPC) as a sole metastatic site are poorly characterized. Whether they behave similarly to other stage IV patients is unknown.
  
  
  METHODS
  Patients with stage IV disease at our institution between 2003 and 2013 were identified. Inclusion criteria for PPC cohort were PPC at laparoscopy and no laparoscopic and/or radiographic evidence of metastasis. Patients with gross metastasis had laparoscopic and/or radiographic evidence of metastasis.
  
  
  RESULTS
  Among 308 patients, 43 patients had PPC and 265 had gross metastasis. PPC cohort: 3 (7%) resectable, 8 (19%) borderline resectable, and 32 (74%) unresectable tumor. Disease progression occurred in 37 (86%). Sixteen of 43 (37%) also received local therapy (1 surgery and 15 chemoradiation). PPC vs gross metastasis cohort differed as follows: baseline Ca 19-9 (440 vs 1,904 IU/mL, P < .0001); Eastern Cooperative Oncology Group (ECOG) score ≤1 (98 vs 88%, P = .04); median overall survival (13.9 vs 9.4 months, P = .0001).
  
  
  CONCLUSIONS
  Patients with PPC failed to display long-term disease-free survival, although overall survival was superior compared with those with gross metastasis. Patients with PPC may need to be considered a specific subgroup for staging and survival analysis.
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Cancer Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: Mandelson
authors.affiliation: Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Hejin
authors.initials: H
authors.lastname: Hahn
authors.affiliation: Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Alseidi
authors.affiliation: Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Biehl
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
authors.affiliation: Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Flavio G
authors.initials: FG
authors.lastname: Rocha
authors.affiliation: Department of General Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Helton
authors.affiliation: Department of Medical Oncology, Virginia Mason Medical Center, 1100 9th Avenue, MS: C2-HEM, Seattle, WA 98111, USA. Electronic address: Vincent.Picozzi@virginiamason.org.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Picozzi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D010537:Peritoneum / Q000473:pathology*; D012189:Retrospective Studies
keywords: Cancer staging; Chemoradiation; Disease progression; Laparoscopy; Peritoneal washing; Survival