부산대학교 도서관

Background and aim Staging laparoscopy is an important step of the staging of gastric cancer patients, however, its indication are universally accepted by the different guidelines.This study aimed to define those factors which could help in defining the most appropriate use of staging laparoscopy in a western population. Methods A retrospective cohort study was carried out, including 330 (226 cM- and 104 cM+) gastric cancer patients who had undergone staging laparoscopy between 2010–2020 in seven GIRCG centers. A model including easily-accessible clinical, biochemical and pathological markers was constructed to predict the risk of carcinomatosis. ROC curve and decision curve analyses were used to verify its accuracy and net benefit. Results In the cM- population staging laparoscopy could detect 70 cases who had peritoneal carcinomatosis or positive cytology, for a yield of 31.0%. In cM+ patients staging laparoscopy could exclude carcinomatosis in 15 cases. In cM- patients, intestinal type tumors (0.36, 0.14–0.92; P  = 0.035), the presence of signet ring cells (2.58, 1.04–6.33; P  = 0.039) and cancers of the upper third (3.36, 1.43–7.92; P  = 0.005) were associated with the presence of peritoneal carcinomatosis and/or positive cytology. The ROC curve analysis of the model including the three variables showed an AUC of 0.75 (0.66–0.80, P  < 0.001). The decision curve analyses showed that the model had a higher net benefit than the treating all strategy between threshold probabilities of 16 and 50%. Conclusion Staging laparoscopy is a useful tool to address the patient with gastric cancer to the most adequate treatment. In cM- patients the assessment of the location of the tumor, the Lauren's histotype and the presence of signet ring cells may help in providing additional elements in indicating or not the use of staging laparoscopy. [ABSTRACT FROM AUTHOR]