Open AccessAn ascites grading system for predicting the prognosis of gastric cancer with peritoneum dissemination
Author(s) -
Honda Michitaka,
Kawamura Hidetaka,
Kobayashi Hiroshi,
Takiguchi Koichi,
Muto Atsushi,
Yamazaki Shigeru,
Teranishi Yasushi,
Shiraso Satoru,
Kono Koji,
Hori Soshi,
Kamiga Takahiro,
Iwao Toshiyasu,
Yamashita Naoyuki
Publication year - 2020
Publication title -
annals of gastroenterological surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.308
H-Index - 15
ISSN - 2475-0328
DOI - 10.1002/ags3.12386
Subject(s) - ascites , medicine , hazard ratio , grading (engineering) , abdominal cavity , peritoneal cavity , peritoneum , radiology , cancer , gastroenterology , surgery , confidence interval , civil engineering , engineering
Aim Gastric cancer with peritoneum dissemination is intractable with surgical resection. The evaluation of the degree of dissemination using computed tomography (CT) is difficult. We focused on the amount of ascites based on CT findings and established a scaling system to predict these patients’ prognoses. Methods We extracted individual data from a population‐based cohort. Patients diagnosed with histologically proven gastric adenocarcinoma with peritoneum dissemination were enrolled. Two raters evaluated the CT images and determined the grade of ascites in each patient: grade 0 indicated no ascites in all slices; grade 1 indicated ascites detected only in the upper or lower abdominal cavity; grade 2 indicated ascites detected in both the upper and lower abdominal cavities; and grade 3 indicated ascites extending continuously from the pelvic cavity to the upper abdominal cavity. We evaluated the relationship between the ascites grade and survival time. After adjusting for other clinical factors, we calculated hazard ratios of each ascites grade. Results A total of 718 patients were enrolled. The number of patients with grades 0, 1, 2, and 3 were 303, 223, 94, and 98, respectively. The median overall survival times were 16.0, 8.7, 5.4, and 3.0 months for ascites on CT grades 0, 1, 2, and 3, respectively ( P < .001). The adjusted hazard ratios for the survival time were 1.74 (1.33‐2.26, P < .001), 3.20 (2.25‐4.57, P < .001), and 4.76 (3.16‐7.17, P < .001) for grades 1, 2, and 3, respectively. Conclusion We established a new grading system of pretreatment ascites to better predict the prognosis of gastric cancer.