human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background In gastric cancer patients who have positive results for peritoneal lavage cytology the disease is defined as CY1 , and classified as stage IV , and this population has generally suffered a dismal outcome . For this population , we had conducted a phase II trial , with the 2-year survival rate as the primary endpoint , to test the strategy of D2 dissection followed by chemotherapy with single-agent S-1 ( 1 M tegafur–0.4 M gimestat–1 M otastat potassium ) .  Forty-eight patients were enrolled , of whom 47 were found to have been eligible for analysis . The 2-year survival rate of 46 % exceeded our expectations . Methods Further follow up was conducted to confirm whether radical surgery could be recommended for the CY1 population . Results The 5-year overall and relapse-free survival rates were 26 and 21 % , respectively . Conclusions Gastrectomy with curative intent could be considered for patients with CY1 disease provided they are scheduled to receive effective postoperative chemotherapy Background .Positive peritoneal cytology is a predictor of poor survival in patients with gastric cancer . Our aim is to more clearly define the natural history of this cohort . Methods . Review of a prospect ively maintained gastric cancer data base of patients who had diagnostic laparoscopy with peritoneal washings .  Clinicopathologic and treatmentrelated variables were obtained . Univariate and multivariate analyses were performed for factors associated with disease-specific survival ( DSS ) . Results .From January 1993 to April 2009 , a total of 1241 patients with gastric cancer underwent laparoscopy with peritoneal washings ; 291 ( 23 % ) had positive cytology . There were 198 patients ( 68 % ) who had visible metastases discovered at laparoscopy ( M1 ) , and 93 patients ( 32 % ) were without gross evidence of advanced disease ( M1 Cyt+ ) . The median DSS for the entire cohort was 1 year ; for M1 , DSS was 0.8 years , and for M1 Cyt+ , DSS was 1.3 years . At baseline , independent predictors of worse DSS were poor performance status , M1 disease , and diffuse tumors . Among the subset of patients with M1 Cyt + disease , performance status was the strongest independent predictor of DSS . A total of 48 of the 291 Cyt + patients had repeat staging laparoscopy after chemotherapy . Compared with patients who had persistently positive cytology ( n = 21 ) , those who converted to negative cytology ( n = 27 ) had a significant improvement in DSS ( 2.5 years vs. 1.4 years , P = 0.0003 ) . Conclusions . Patients with positive cytology as the only evidence of advanced disease exhibit a poor outcome ; however , clearing of Cyt + disease by chemotherapy is associated with a statistically significant improvement in DSS . The role for gastrectomy in patients with positive peritoneal cytology remains uncertain Purpose The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear . One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established . The aim of this study was to evaluate the efficacy of cytology using sample s harvested from two different abdominal cavity sites during gastric cancer surgery . Material s and Methods We prospect ively recruited 108 patients who were clinical ly diagnosed with locally advanced gastric cancer ( higher than cT1 stage disease ) .  Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area . Patients were prospect ively followed up for 2 years to determine the recurrence and survival rates . Results Thirty-three patients dropped out of the study for various reasons , so 75 patients were included in the final analysis . Seven patients ( 9.3 % ) showed positive cytology findings , of whom , three showed peritoneal recurrence . Tumor size was the only factor associated with positive cytology findings ( P=0.037 ) . The accuracy and specificity of cytology  for predicting peritoneal recurrence were 90.1 % and 94.2 % , respectively , whereas the sensitivity was 50.0 % . The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings ( P=0.081 ) . Conclusions Peritoneal washing cytology using sample s harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients . Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure Background The present study was design ed to assess the feasibility and efficiency of intraperitoneal and intravenous neoadjuvant chemotherapy in gastric cancer patients with peritoneal dissemination . Methods The study subjects were 25 treatment-naïve patients with gastric cancer . Patients with positive cytology or with peritoneal carcinomatosis received neoadjuvant intraperitoneal and systemic chemotherapy ( NIPS ) , comprising intraperitoneal ( i.p . ) mitomycin C ( MMC ) and cisplatin ( CDDP ) , followed by two cycles of intravenous triplet chemotherapy of docetaxel , 5-fluorouracil ( 5-FU ) , and CDDP . Gastrectomy with lymph node dissection was performed after NIPS in patients free of peritoneal deposits , confirmed by staging laparoscopy . Results Seventeen patients had measurable lymph node metastases by the RECIST criteria . CT examination showed response to the treatment in ten ( 59 % , 0 complete response , 10 partial response ) . Of the 25 patients , 14 ( 56 % ) showed negative results on peritoneal cytology with no macroscopic peritoneal metastasis , whereas the remaining 11 were cancer cell-positive on peritoneal cytology or macroscopic peritoneal metastasis even after NIPS . The median survival time for all 25 patients was 16.7 months . Prognosis was better in patients who showed negative cytology and disappearance of peritoneal cancer metastases after NIPS than in those with positive cytology or existing peritoneal deposits ( P < 0.0001 ) . The predominant toxicity was myelosuppression and grade 3–4 leukopenia and neutropenia occurred in 20 ( 80 % ) patients , which were manageable . No treatment-related mortality was observed during and after NIPS and surgery . Conclusions The results of this prospect i ve phase II study indicated that the newly design ed NIPS was highly effective and well tolerated in patients with advanced gastric cancer and peritoneal dissemination Background Although positive peritoneal cytology is associated with poor prognosis , it has not been found to be independently predictive of outcome when evaluated in context of post-resection pathologic T and N stage . This study was undertaken to evaluate the predictive value of positive cytology in context of other prognostic factors available prior to surgery in patients undergoing R0 resection for gastric cancer , to assess its role in selecting patients for appropriate treatment prior to surgical resection . Methods Clinical variables for all patients undergoing R0 resection for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1993–2002 were review ed from a prospect i ve data base . Patients underwent preoperative assessment of T and N stage with CT scan , laparoscopy , and endoscopic and /or laparoscopic ultrasound . Peritoneal cytology was obtained in all patients . Results Patients with gastric cancer ( n = 371 ) underwent R0 resection and staging laparoscopy with peritoneal washings ; 24 patients ( 6.5 % ) had positive peritoneal cytology . Positive cytology was associated with advanced T stage ( P = 0.02 ) but not with nodal positivity ( P = 0.11 ) . Median survival of patients with positive cytology was 14.8 months vs. 98.5 months for patients with negative cytology ( P < 0.001 ) . Multivariate analysis identified preoperative T stage , preoperative N stage , site , and cytology as significant predictors of outcome . Positive cytology was the preoperative factor most predictive of death from gastric cancer ( RR 2.7 , P < 0.001 ) . Conclusions Positive cytology is information potentially available preoperatively that identifies a patient population at very high risk for early recurrence and death after curative resection of gastric cancer Peritoneal recurrence is the foremost pattern of failure after potentially curative resection for gastric cancer . Our aim was to evaluate the prognostic value of intraperitoneal free cancer cells ( IFCCs ) in peritoneal lavage of patients who underwent potentially curative resection for gastric carcinoma . Two hundred twenty patients with gastric cancer stage I , II , or III were prospect ively evaluated with peritoneal lavage and cytologic examination . Aspirated fluid from the abdominal cavity was centrifuged and subjected to Papanicolaou staining .  The mean age was 60.9 years ( range , 21–89 years ) , and 63.6 % were men . IFCCs were detected in 6.8 % of the patients ; suspicious in 2.7 % , and negative in 84.5 % . No judgment could be given in 5.9 % of the cases . Invasion of the gastric serosa ( pT3 ) was observed in all positive cytology patients . Patients with IFCCs had a mean survival time of 10.5 months , while those with negative IFCC had a mean survival time of 61 months ( P = 0.00001 ) . There was no correlation between the presence of IFCCs and tumor size , histology , pN , or tumor site . Our conclusions are that ( 1 ) positive cytology indicates a poor prognosis in patients who underwent potentially curative gastric resection  and ( 2 ) peritoneal lavage cytology improves staging in assessing these patients and may alter their therapeutic approach A r and omized controlled trial has started in both Japan and Korea to evaluate the role of gastrectomy in the management of incurable advanced gastric cancer ( AGC ) . Patients with AGC diagnosed as having a single non-curable factor are r and omized to gastrectomy plus chemotherapy or chemotherapy alone . Surgeons at 33 specialized centers in Japan and at 15 high-volume hospitals in Korea will recruit 330 patients . Primary end-point is overall survival , and secondary end-points are progression-free survival and adverse events associated with either gastrectomy or chemotherapy Purpose The aim of this study was to evaluate the significance of the conversion of the peritoneal cytology from positive to negative following induction chemotherapy in relation to the prognosis after subsequent resection for gastric cancer . Methods This retrospective study was conducted using a prospect ively maintained data base . A total of 47 patients with free cancer cells in the peritoneal cavity , as evaluated by staging laparoscopy , but no other evidence of distant metastasis , who underwent induction chemotherapy followed by surgery were enrolled in the study . Then , the clinicopathological factors and survival in the study subjects were assessed . Results The median survival time and 5-year overall survival rate of the 47 study participants were 20.4 months and 25.0 % , respectively . In 23 of the patients , the peritoneal cytology converted from positive to negative after the induction chemotherapy , and a microscopically margin-negative gastrectomy was performed . The median survival time of 30.4 months and the 5-year survival rate of 34.6 % of these patients was significantly more favorable than the corresponding values of 15.0 months and 17.6 % in the patients who had persistently positive cytology ( P = 0.03 ) . Conclusion Based on our findings , the clearance of free cancer cells in the peritoneal cavity by induction chemotherapy improves the prognosis of patients following subsequent gastrectomy OBJECTIVES A multi-center phase II study was conducted to evaluate the safety and efficacy of neoadjuvant chemotherapy ( NAC ) with S-1 plus cisplatin for advanced gastric cancer . METHODS The eligibility criteria were clinical T3/T4 or N2 , not Stage IV . Patients received two 35-day cycles of S-1 plus cisplatin , and then underwent D2 gastrectomy . The primary endpoint was 3-year progression free survival ( PFS ) . Secondary endpoints were ratio of R0 resection , response rate , adverse events , and overall survival . A sample size of 49 was determined to have 80 % power for detecting 15 % improvement in the 3-year PFS over 55 % at a one-sided alpha of 0.1 . RESULTS Among 53 patients enrolled , 44 patients completed two cycles of NAC ( 83 % ) , and 48 patients underwent R0 resection ( 91 % ) . Postoperative complications occurred in 13 patients ( 26 % ) . A pathological response was confirmed in 24 patients ( 45 % ) , including four complete responses . The 3-year PFS was 50.7 % , while the 3-year OS was 74.9 % . CONCLUSIONS Although the observed 3-year PFS rate was worse than expected , NAC with S1 plus cisplatin was safe and led to a high rate of R0 resection . A r and omized controlled trial is needed to make conclusions about the effectiveness of NAC in Japanese patients undergoing D2 resection The poor prognosis of patients with gastric cancer with free abdominal tumour cells on cytological examination has been described in Japan . In a r and omized trial in 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background In gastric cancer patients who have positive results for peritoneal lavage cytology the disease is defined as CY1 , and classified as stage IV , and this population has generally suffered a dismal outcome . For this population , we had conducted a phase II trial , with the 2-year survival rate as the primary endpoint , to test the strategy of D2 dissection followed by chemotherapy with single-agent S-1 ( 1 M tegafur–0.4 M gimestat–1 M otastat potassium ) .  Forty-eight patients were enrolled , of whom 47 were found to have been eligible for analysis . The 2-year survival rate of 46 % exceeded our expectations . Methods Further follow up was conducted to confirm whether radical surgery could be recommended for the CY1 population . Results The 5-year overall and relapse-free survival rates were 26 and 21 % , respectively . Conclusions Gastrectomy with curative intent could be considered for patients with CY1 disease provided they are scheduled to receive effective postoperative chemotherapy Background .Positive peritoneal cytology is a predictor of poor survival in patients with gastric cancer . Our aim is to more clearly define the natural history of this cohort . Methods . Review of a prospect ively maintained gastric cancer data base of patients who had diagnostic laparoscopy with peritoneal washings .  Clinicopathologic and treatmentrelated variables were obtained . Univariate and multivariate analyses were performed for factors associated with disease-specific survival ( DSS ) . Results .From January 1993 to April 2009 , a total of 1241 patients with gastric cancer underwent laparoscopy with peritoneal washings ; 291 ( 23 % ) had positive cytology . There were 198 patients ( 68 % ) who had visible metastases discovered at laparoscopy ( M1 ) , and 93 patients ( 32 % ) were without gross evidence of advanced disease ( M1 Cyt+ ) . The median DSS for the entire cohort was 1 year ; for M1 , DSS was 0.8 years , and for M1 Cyt+ , DSS was 1.3 years . At baseline , independent predictors of worse DSS were poor performance status , M1 disease , and diffuse tumors . Among the subset of patients with M1 Cyt + disease , performance status was the strongest independent predictor of DSS . A total of 48 of the 291 Cyt + patients had repeat staging laparoscopy after chemotherapy . Compared with patients who had persistently positive cytology ( n = 21 ) , those who converted to negative cytology ( n = 27 ) had a significant improvement in DSS ( 2.5 years vs. 1.4 years , P = 0.0003 ) . Conclusions . Patients with positive cytology as the only evidence of advanced disease exhibit a poor outcome ; however , clearing of Cyt + disease by chemotherapy is associated with a statistically significant improvement in DSS . The role for gastrectomy in patients with positive peritoneal cytology remains uncertain Purpose The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear . One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established . The aim of this study was to evaluate the efficacy of cytology using sample s harvested from two different abdominal cavity sites during gastric cancer surgery . Material s and Methods We prospect ively recruited 108 patients who were clinical ly diagnosed with locally advanced gastric cancer ( higher than cT1 stage disease ) .  Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area . Patients were prospect ively followed up for 2 years to determine the recurrence and survival rates . Results Thirty-three patients dropped out of the study for various reasons , so 75 patients were included in the final analysis . Seven patients ( 9.3 % ) showed positive cytology findings , of whom , three showed peritoneal recurrence . Tumor size was the only factor associated with positive cytology findings ( P=0.037 ) . The accuracy and specificity of cytology  for predicting peritoneal recurrence were 90.1 % and 94.2 % , respectively , whereas the sensitivity was 50.0 % . The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings ( P=0.081 ) . Conclusions Peritoneal washing cytology using sample s harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients . Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure Background The present study was design ed to assess the feasibility and efficiency of intraperitoneal and intravenous neoadjuvant chemotherapy in gastric cancer patients with peritoneal dissemination . Methods The study subjects were 25 treatment-naïve patients with gastric cancer . Patients with positive cytology or with peritoneal carcinomatosis received neoadjuvant intraperitoneal and systemic chemotherapy ( NIPS ) , comprising intraperitoneal ( i.p . ) mitomycin C ( MMC ) and cisplatin ( CDDP ) , followed by two cycles of intravenous triplet chemotherapy of docetaxel , 5-fluorouracil ( 5-FU ) , and CDDP . Gastrectomy with lymph node dissection was performed after NIPS in patients free of peritoneal deposits , confirmed by staging laparoscopy . Results Seventeen patients had measurable lymph node metastases by the RECIST criteria . CT examination showed response to the treatment in ten ( 59 % , 0 complete response , 10 partial response ) . Of the 25 patients , 14 ( 56 % ) showed negative results on peritoneal cytology with no macroscopic peritoneal metastasis , whereas the remaining 11 were cancer cell-positive on peritoneal cytology or macroscopic peritoneal metastasis even after NIPS . The median survival time for all 25 patients was 16.7 months . Prognosis was better in patients who showed negative cytology and disappearance of peritoneal cancer metastases after NIPS than in those with positive cytology or existing peritoneal deposits ( P < 0.0001 ) . The predominant toxicity was myelosuppression and grade 3–4 leukopenia and neutropenia occurred in 20 ( 80 % ) patients , which were manageable . No treatment-related mortality was observed during and after NIPS and surgery . Conclusions The results of this prospect i ve phase II study indicated that the newly design ed NIPS was highly effective and well tolerated in patients with advanced gastric cancer and peritoneal dissemination Background Although positive peritoneal cytology is associated with poor prognosis , it has not been found to be independently predictive of outcome when evaluated in context of post-resection pathologic T and N stage . This study was undertaken to evaluate the predictive value of positive cytology in context of other prognostic factors available prior to surgery in patients undergoing R0 resection for gastric cancer , to assess its role in selecting patients for appropriate treatment prior to surgical resection . Methods Clinical variables for all patients undergoing R0 resection for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1993–2002 were review ed from a prospect i ve data base . Patients underwent preoperative assessment of T and N stage with CT scan , laparoscopy , and endoscopic and /or laparoscopic ultrasound . Peritoneal cytology was obtained in all patients . Results Patients with gastric cancer ( n = 371 ) underwent R0 resection and staging laparoscopy with peritoneal washings ; 24 patients ( 6.5 % ) had positive peritoneal cytology . Positive cytology was associated with advanced T stage ( P = 0.02 ) but not with nodal positivity ( P = 0.11 ) . Median survival of patients with positive cytology was 14.8 months vs. 98.5 months for patients with negative cytology ( P < 0.001 ) . Multivariate analysis identified preoperative T stage , preoperative N stage , site , and cytology as significant predictors of outcome . Positive cytology was the preoperative factor most predictive of death from gastric cancer ( RR 2.7 , P < 0.001 ) . Conclusions Positive cytology is information potentially available preoperatively that identifies a patient population at very high risk for early recurrence and death after curative resection of gastric cancer Peritoneal recurrence is the foremost pattern of failure after potentially curative resection for gastric cancer . Our aim was to evaluate the prognostic value of intraperitoneal free cancer cells ( IFCCs ) in peritoneal lavage of patients who underwent potentially curative resection for gastric carcinoma . Two hundred twenty patients with gastric cancer stage I , II , or III were prospect ively evaluated with peritoneal lavage and cytologic examination . Aspirated fluid from the abdominal cavity was centrifuged and subjected to Papanicolaou staining .  The mean age was 60.9 years ( range , 21–89 years ) , and 63.6 % were men . IFCCs were detected in 6.8 % of the patients ; suspicious in 2.7 % , and negative in 84.5 % . No judgment could be given in 5.9 % of the cases . Invasion of the gastric serosa ( pT3 ) was observed in all positive cytology patients . Patients with IFCCs had a mean survival time of 10.5 months , while those with negative IFCC had a mean survival time of 61 months ( P = 0.00001 ) . There was no correlation between the presence of IFCCs and tumor size , histology , pN , or tumor site . Our conclusions are that ( 1 ) positive cytology indicates a poor prognosis in patients who underwent potentially curative gastric resection  and ( 2 ) peritoneal lavage cytology improves staging in assessing these patients and may alter their therapeutic approach A r and omized controlled trial has started in both Japan and Korea to evaluate the role of gastrectomy in the management of incurable advanced gastric cancer ( AGC ) . Patients with AGC diagnosed as having a single non-curable factor are r and omized to gastrectomy plus chemotherapy or chemotherapy alone . Surgeons at 33 specialized centers in Japan and at 15 high-volume hospitals in Korea will recruit 330 patients . Primary end-point is overall survival , and secondary end-points are progression-free survival and adverse events associated with either gastrectomy or chemotherapy Purpose The aim of this study was to evaluate the significance of the conversion of the peritoneal cytology from positive to negative following induction chemotherapy in relation to the prognosis after subsequent resection for gastric cancer . Methods This retrospective study was conducted using a prospect ively maintained data base . A total of 47 patients with free cancer cells in the peritoneal cavity , as evaluated by staging laparoscopy , but no other evidence of distant metastasis , who underwent induction chemotherapy followed by surgery were enrolled in the study . Then , the clinicopathological factors and survival in the study subjects were assessed . Results The median survival time and 5-year overall survival rate of the 47 study participants were 20.4 months and 25.0 % , respectively . In 23 of the patients , the peritoneal cytology converted from positive to negative after the induction chemotherapy , and a microscopically margin-negative gastrectomy was performed . The median survival time of 30.4 months and the 5-year survival rate of 34.6 % of these patients was significantly more favorable than the corresponding values of 15.0 months and 17.6 % in the patients who had persistently positive cytology ( P = 0.03 ) . Conclusion Based on our findings , the clearance of free cancer cells in the peritoneal cavity by induction chemotherapy improves the prognosis of patients following subsequent gastrectomy OBJECTIVES A multi-center phase II study was conducted to evaluate the safety and efficacy of neoadjuvant chemotherapy ( NAC ) with S-1 plus cisplatin for advanced gastric cancer . METHODS The eligibility criteria were clinical T3/T4 or N2 , not Stage IV . Patients received two 35-day cycles of S-1 plus cisplatin , and then underwent D2 gastrectomy . The primary endpoint was 3-year progression free survival ( PFS ) . Secondary endpoints were ratio of R0 resection , response rate , adverse events , and overall survival . A sample size of 49 was determined to have 80 % power for detecting 15 % improvement in the 3-year PFS over 55 % at a one-sided alpha of 0.1 . RESULTS Among 53 patients enrolled , 44 patients completed two cycles of NAC ( 83 % ) , and 48 patients underwent R0 resection ( 91 % ) . Postoperative complications occurred in 13 patients ( 26 % ) . A pathological response was confirmed in 24 patients ( 45 % ) , including four complete responses . The 3-year PFS was 50.7 % , while the 3-year OS was 74.9 % . CONCLUSIONS Although the observed 3-year PFS rate was worse than expected , NAC with S1 plus cisplatin was safe and led to a high rate of R0 resection . A r and omized controlled trial is needed to make conclusions about the effectiveness of NAC in Japanese patients undergoing D2 resection The poor prognosis of patients with gastric cancer with free abdominal tumour cells on cytological examination has been described in Japan . In a r and omized trial in 
    Output:
    