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: Summary We prospect ively investigated the prognostic significance of free peritoneal tumour cells ( FPTC ) in a series of 118 patients with completely resected gastric carcinoma .  Immunocytochemistry with the monoclonal antibody Ber-Ep4 was performed on cytospins from intraoperative peritoneal lavage specimens . Twenty-three patients ( 20 % ) had FPTC  which was significantly correlated with pT and pN categories , stage , tumour size , lymphatic invasion , Laurèn and WHO classifications and perigastric adipose tissue metastases . The median survival time for all FPTC positive compared with negative patients was significantly shorter ( 11 compared with > 72 months ) , with estimated 5-year survival rates of 8 % vs. 60 % . None of the patients with FPTC had an early gastric cancer . In advanced tumour subgroups without and with serosal invasion ( n = 59 and 35 ) , there were 19 % and 34 % with FPTC .  Multivariate survival analysis showed nodal status , FPTC , mesenteric lymphangiosis , and lymph node metastasis to the compartment III to be independent prognostic factors with relative risks of 6.6 , 4.5 , 2.9 and 2.2 respectively . Recurrent disease occurred in 91 % of FPTC-positive and in 38 % of FPTC-negative patients . FPTC had a positive predictive value of 91 % and a specificity of 97 % for tumour recurrence .  FPTC is a strong negative , independent prognostic indicator for survival in gastric carcinoma Prediction of peritoneal relapse is extremely important for gastric cancer patients after curative surgery . The present study prospect ively vali date s the prognostic ability of quantifying carcinoembryonic antigen ( CEA ) mRNA in peritoneal washes by real-time reverse transcriptase – polymerase chain reaction . Based on a retrospective study of 197 curatively resected gastric cancer patients ( training set ) , we determined a cutoff value of CEA mRNA using receiver-operating characteristic curve . We used this cutoff value to vali date the risk of peritoneal recurrence in a new cohort of 86 gastric cancer patients ( validation set ) between July 2000 and December 2002 in a prospect i ve study . During the median 30 months of postoperative surveillance , 20 of the 86 patients died , and 13 of the 20 developed peritoneal metastases . Peritoneal recurrence-free survival as well as overall survival was significantly worse in patients with positive CEA mRNA ( P<0.0001 ) . Multivariate analysis with the Cox proportional hazards model showed that positive CEA mRNA was a significant independent risk factor with both survival ( P=0.0130 ) and peritoneal recurrence-free survival ( P=0.0006 ) as end points . These results indicate that quantitation of CEA mRNA in peritoneal washes is a reliable prognostic indicator of peritoneal recurrence in the clinical setting OBJECTIVE Surgeons have postulated on numerous occasions that cancer resection may participate in the dissemination of a malignancy . This r and omized trial sought to determine whether a large volume of chemotherapy solution used perioperatively to flood the peritoneal cavity could eliminate microscopic residual disease and thereby improve survival of patients with gastric cancer . SUMMARY BACKGROUND DATA Surgical treatment failures in patients with gastric cancer are confined to the abdomen in most patients . Resection site and peritoneal surface spread , along with liver metastases , are the most common areas of recurrence . Survival and quality of life of patients with gastric cancer would be improved if disease progression at these anatomic sites was reduced . METHODS In a prospect i ve r and omized trial of 248 patients , intraperitoneal mitomycin C on day 1 and intraperitoneal 5-fluorouracil on days 2 through 5 were administered after gastric cancer resection .  Patients who were thought to have stage II or stage III disease were r and omized after resection to surgery alone versus surgery plus early postoperative intraperitoneal chemotherapy . After final pathologic examinations , there were 39 patients with stage I , 50 with stage II 95 with stage III , and 64 with resected stage IV cancer . RESULTS The 5-year survival of the surgery-only group was 29.3 % , and the surgery-plus-intraperitoneal chemotherapy group was 38.7 % ( p = 0.219 ) . In a subset analysis , the patients with stage I , stage II , and stage IV disease showed no statistically significant difference in survival . The 5-year survival rate of patients with stage III disease who underwent surgery only was 18.4 % versus a survival rate of 49.1 % for patients who underwent surgery plus intraperitoneal chemotherapy ( p = 0.011 ) . CONCLUSIONS In a subset analysis , patients with stage III gastric cancer have shown a statistically significant improvement in survival when treated with perioperative intraperitoneal chemotherapy . Further studies in patients with gastric cancer with surgically directed chemotherapy are suggested 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 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 BACKGROUND AND OBJECTIVES Borrmann type IV gastric carcinoma ( B-4 ) remains a disease with poor prognosis despite an aggressive surgical approach . Cytology examination of the peritoneal washes is an established prognostic factor for gastric carcinoma in general , and may be useful for identifying adequate treatment strategy for B-4 . METHODS Pathologic data from 70 patients with B-4 who underwent laparotomy and peritoneal washing cytology during the recent 6 years were retrieved from a prospect i ve computer data base and review ed . Prognostic significance of the cytology examination along with other known clinicopathologic variables was evaluated by univariate and multivariate analyses . RESULTS Long-term survivors were observed only among the patients who were treated with curative R0 resection . Prognosis of the patients with positive cytology and no other residual disease ( R1 ) was extremely poor and was equivalent to that of the patients undergoing noncurative R2 resection . No difference in survival , either , was observed between the patients treated by R2 resection and those who did not undergo resection . Multivariate analysis identified cytology examination as an independent prognostic factor . CONCLUSIONS Peritoneal washing cytology plays an important role in staging B4 . Positive cytology findings as well as other evidence of disseminated disease may indicate that gastrectomy should be avoided Background We have previously reported the molecular detection of peritoneal micrometastases in patients with gastric cancer by quantifying carcinoembryonic antigen ( CEA ) mRNA in the peritoneal washes . Patients with CEA mRNA exceeding a cutoff value have a significant risk for developing peritoneal carcinomatosis , but optimal treatment for this population remains unknown . Methods CEA mRNA ( + ) patients with gastric cancer were treated postoperatively with S-1 monotherapy .  Overall survival , the primary endpoint of this phase II trial , was compared with the historical control , which is comprised of CEA mRNA ( + ) patients who were not given postoperative chemotherapy . Results A total of 32 patients with CEA mRNA ( + ) gastric cancer were enrolled . Twelve patients ( 37.5 % ) relapsed ; ten showed peritoneal relapse . Three-year survival was similar between the study population and the historical control ( 67.3 % vs. 67.1 % , respectively ) . Conclusions S-1 monotherapy , which significantly reduced risk for recurrence in stage II/III gastric carcinoma in another phase III trial , seems not to be as effective in eradicating free cancer cells in the abdominal cavity 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 the Netherl and s comparing D1 and D2 lymphadenectomy for gastric cancer , patients were subjected to cytological examination of abdominal washings on an optional basis ; findings were of no consequence for scheduled treatment . Cytology results in 535 patients were obtained , in 457 ( 85·4 per cent ) after curative resection and in 78 ( 14· 
    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: Summary We prospect ively investigated the prognostic significance of free peritoneal tumour cells ( FPTC ) in a series of 118 patients with completely resected gastric carcinoma .  Immunocytochemistry with the monoclonal antibody Ber-Ep4 was performed on cytospins from intraoperative peritoneal lavage specimens . Twenty-three patients ( 20 % ) had FPTC  which was significantly correlated with pT and pN categories , stage , tumour size , lymphatic invasion , Laurèn and WHO classifications and perigastric adipose tissue metastases . The median survival time for all FPTC positive compared with negative patients was significantly shorter ( 11 compared with > 72 months ) , with estimated 5-year survival rates of 8 % vs. 60 % . None of the patients with FPTC had an early gastric cancer . In advanced tumour subgroups without and with serosal invasion ( n = 59 and 35 ) , there were 19 % and 34 % with FPTC .  Multivariate survival analysis showed nodal status , FPTC , mesenteric lymphangiosis , and lymph node metastasis to the compartment III to be independent prognostic factors with relative risks of 6.6 , 4.5 , 2.9 and 2.2 respectively . Recurrent disease occurred in 91 % of FPTC-positive and in 38 % of FPTC-negative patients . FPTC had a positive predictive value of 91 % and a specificity of 97 % for tumour recurrence .  FPTC is a strong negative , independent prognostic indicator for survival in gastric carcinoma Prediction of peritoneal relapse is extremely important for gastric cancer patients after curative surgery . The present study prospect ively vali date s the prognostic ability of quantifying carcinoembryonic antigen ( CEA ) mRNA in peritoneal washes by real-time reverse transcriptase – polymerase chain reaction . Based on a retrospective study of 197 curatively resected gastric cancer patients ( training set ) , we determined a cutoff value of CEA mRNA using receiver-operating characteristic curve . We used this cutoff value to vali date the risk of peritoneal recurrence in a new cohort of 86 gastric cancer patients ( validation set ) between July 2000 and December 2002 in a prospect i ve study . During the median 30 months of postoperative surveillance , 20 of the 86 patients died , and 13 of the 20 developed peritoneal metastases . Peritoneal recurrence-free survival as well as overall survival was significantly worse in patients with positive CEA mRNA ( P<0.0001 ) . Multivariate analysis with the Cox proportional hazards model showed that positive CEA mRNA was a significant independent risk factor with both survival ( P=0.0130 ) and peritoneal recurrence-free survival ( P=0.0006 ) as end points . These results indicate that quantitation of CEA mRNA in peritoneal washes is a reliable prognostic indicator of peritoneal recurrence in the clinical setting OBJECTIVE Surgeons have postulated on numerous occasions that cancer resection may participate in the dissemination of a malignancy . This r and omized trial sought to determine whether a large volume of chemotherapy solution used perioperatively to flood the peritoneal cavity could eliminate microscopic residual disease and thereby improve survival of patients with gastric cancer . SUMMARY BACKGROUND DATA Surgical treatment failures in patients with gastric cancer are confined to the abdomen in most patients . Resection site and peritoneal surface spread , along with liver metastases , are the most common areas of recurrence . Survival and quality of life of patients with gastric cancer would be improved if disease progression at these anatomic sites was reduced . METHODS In a prospect i ve r and omized trial of 248 patients , intraperitoneal mitomycin C on day 1 and intraperitoneal 5-fluorouracil on days 2 through 5 were administered after gastric cancer resection .  Patients who were thought to have stage II or stage III disease were r and omized after resection to surgery alone versus surgery plus early postoperative intraperitoneal chemotherapy . After final pathologic examinations , there were 39 patients with stage I , 50 with stage II 95 with stage III , and 64 with resected stage IV cancer . RESULTS The 5-year survival of the surgery-only group was 29.3 % , and the surgery-plus-intraperitoneal chemotherapy group was 38.7 % ( p = 0.219 ) . In a subset analysis , the patients with stage I , stage II , and stage IV disease showed no statistically significant difference in survival . The 5-year survival rate of patients with stage III disease who underwent surgery only was 18.4 % versus a survival rate of 49.1 % for patients who underwent surgery plus intraperitoneal chemotherapy ( p = 0.011 ) . CONCLUSIONS In a subset analysis , patients with stage III gastric cancer have shown a statistically significant improvement in survival when treated with perioperative intraperitoneal chemotherapy . Further studies in patients with gastric cancer with surgically directed chemotherapy are suggested 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 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 BACKGROUND AND OBJECTIVES Borrmann type IV gastric carcinoma ( B-4 ) remains a disease with poor prognosis despite an aggressive surgical approach . Cytology examination of the peritoneal washes is an established prognostic factor for gastric carcinoma in general , and may be useful for identifying adequate treatment strategy for B-4 . METHODS Pathologic data from 70 patients with B-4 who underwent laparotomy and peritoneal washing cytology during the recent 6 years were retrieved from a prospect i ve computer data base and review ed . Prognostic significance of the cytology examination along with other known clinicopathologic variables was evaluated by univariate and multivariate analyses . RESULTS Long-term survivors were observed only among the patients who were treated with curative R0 resection . Prognosis of the patients with positive cytology and no other residual disease ( R1 ) was extremely poor and was equivalent to that of the patients undergoing noncurative R2 resection . No difference in survival , either , was observed between the patients treated by R2 resection and those who did not undergo resection . Multivariate analysis identified cytology examination as an independent prognostic factor . CONCLUSIONS Peritoneal washing cytology plays an important role in staging B4 . Positive cytology findings as well as other evidence of disseminated disease may indicate that gastrectomy should be avoided Background We have previously reported the molecular detection of peritoneal micrometastases in patients with gastric cancer by quantifying carcinoembryonic antigen ( CEA ) mRNA in the peritoneal washes . Patients with CEA mRNA exceeding a cutoff value have a significant risk for developing peritoneal carcinomatosis , but optimal treatment for this population remains unknown . Methods CEA mRNA ( + ) patients with gastric cancer were treated postoperatively with S-1 monotherapy .  Overall survival , the primary endpoint of this phase II trial , was compared with the historical control , which is comprised of CEA mRNA ( + ) patients who were not given postoperative chemotherapy . Results A total of 32 patients with CEA mRNA ( + ) gastric cancer were enrolled . Twelve patients ( 37.5 % ) relapsed ; ten showed peritoneal relapse . Three-year survival was similar between the study population and the historical control ( 67.3 % vs. 67.1 % , respectively ) . Conclusions S-1 monotherapy , which significantly reduced risk for recurrence in stage II/III gastric carcinoma in another phase III trial , seems not to be as effective in eradicating free cancer cells in the abdominal cavity 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 the Netherl and s comparing D1 and D2 lymphadenectomy for gastric cancer , patients were subjected to cytological examination of abdominal washings on an optional basis ; findings were of no consequence for scheduled treatment . Cytology results in 535 patients were obtained , in 457 ( 85·4 per cent ) after curative resection and in 78 ( 14· 
    Output:
    