title: Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis.
abstract: Intraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells -positive patients had higher rates of nodal spread (risk difference: 0.29; p<0.01), serosal invasion (risk difference: 0.43; p<0.01), recurrence (after 60 months of follow-up, risk difference: 0.44; p<0.01), and mortality (after 60 months of follow-up, risk difference: 0.34; p<0.01). Intraperitoneal free cancer cells are associated with a poor outcome in gastric cancer. This surrogate biomarker should be used to guide therapy both prior to and after surgery.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Tustumi
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Andre Roncon
authors.initials: AR
authors.lastname: Dias
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Marcus Fernando Kodama Pertille
authors.initials: MF
authors.lastname: Ramos
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Zilberstein
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro-Júnior
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D005751:Gastric Lavage; D006801:Humans; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D010529:Peritoneal Cavity / Q000473:pathology*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology*