The British journal of surgery · 2026
Diagnostic accuracy of staging laparoscopy and development of a simple predictive score for peritoneal disease in advanced gastric cancer.
СтатьяОценочное исследованиеНазвание и аннотация: Перевод в очереди
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Kudou Kensuke, Irino Tomoyuki, Ri Motonari, Hayami Masaru, Nunobe Souya
Аннотация
BACKGROUND: Staging laparoscopy (SL) enables direct detection of peritoneal disease (PD), including peritoneal dissemination (P1) and positive peritoneal cytology (CY1), which are often undetectable by preoperative imaging for patients with gastric cancer (GC). The aim of this study was to evaluate the diagnostic accuracy of SL and to develop a simple preoperative scoring system for predicting PD.
METHODS: A total of 889 patients with advanced GC who underwent SL were retrospectively reviewed. After excluding 128 post-chemotherapy patients, 761 treatment-naive patients were analysed. Clinicopathological variables were compared between PD- and PD+ groups, and predictors of PD were identified. A simple predictive score was constructed based on significant independent factors.
RESULTS: PD was detected by SL in 418 patients (54.9%). Positivity rates by indication were 61.7% for type 4 tumours, 51.1% for large type 3 tumours (diameter ≥8 cm), 24.2% for bulky lymph nodes or para-aortic lymph node enlargement, and 76.8% for CT-suspected peritoneal dissemination. The sensitivity, specificity, and overall accuracy of SL were 94.6%, 100%, and 96.8% respectively. Multivariate analysis identified four independent predictors of PD: carbohydrate antigen 19-9 (CA19-9) >37 U/ml; cancer antigen 125 (CA125) >35 U/ml; poorly differentiated or signet-ring cell histology; and pan-regional tumour involvement. A scoring system (range 0-6) based on these variables demonstrated a stepwise increase in PD incidence, from 32.4% for a score of zero to 100% for a score of six.
CONCLUSION: SL demonstrates excellent diagnostic accuracy for detecting PD in advanced GC. The proposed four-factor predictive score provides a simple and practical tool for estimating PD risk, potentially allowing for more selective and rational use of SL.
METHODS: A total of 889 patients with advanced GC who underwent SL were retrospectively reviewed. After excluding 128 post-chemotherapy patients, 761 treatment-naive patients were analysed. Clinicopathological variables were compared between PD- and PD+ groups, and predictors of PD were identified. A simple predictive score was constructed based on significant independent factors.
RESULTS: PD was detected by SL in 418 patients (54.9%). Positivity rates by indication were 61.7% for type 4 tumours, 51.1% for large type 3 tumours (diameter ≥8 cm), 24.2% for bulky lymph nodes or para-aortic lymph node enlargement, and 76.8% for CT-suspected peritoneal dissemination. The sensitivity, specificity, and overall accuracy of SL were 94.6%, 100%, and 96.8% respectively. Multivariate analysis identified four independent predictors of PD: carbohydrate antigen 19-9 (CA19-9) >37 U/ml; cancer antigen 125 (CA125) >35 U/ml; poorly differentiated or signet-ring cell histology; and pan-regional tumour involvement. A scoring system (range 0-6) based on these variables demonstrated a stepwise increase in PD incidence, from 32.4% for a score of zero to 100% for a score of six.
CONCLUSION: SL demonstrates excellent diagnostic accuracy for detecting PD in advanced GC. The proposed four-factor predictive score provides a simple and practical tool for estimating PD risk, potentially allowing for more selective and rational use of SL.