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 Background This r and omized phase III study was to evaluate the efficacy and safety of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) for the treatment of peritoneal carcinomatosis ( PC ) from gastric cancer . Methods Sixty-eight gastric PC patients were r and omized into CRS alone ( n = 34 ) or CRS + HIPEC ( n = 34 ) receiving cisplatin 120 mg and mitomycin C 30 mg each in 6000 ml of normal saline at 43 ± 0.5 ° C for 60–90 min . The primary end point was overall survival , and the secondary end points were safety profiles . Results Major clinicopathological characteristics were balanced between the 2 groups . The PC index was 2–36 ( median 15 ) in the CRS + HIPEC and 3–23 ( median 15 ) in the CRS groups ( P = 0.489 ) . The completeness of CRS score ( CC 0–1 ) was 58.8 % ( 20 of 34 ) in the CRS and 58.8 % ( 20 of 34 ) in the CRS + HIPEC groups ( P = 1.000 ) . At a median follow-up of 32 months ( 7.5–83.5 months ) , death occurred in 33 of 34 ( 97.1 % ) cases in the CRS group and 29 of 34 ( 85.3 % ) cases of the CRS + HIPEC group . The median survival was 6.5 months ( 95 % confidence interval 4.8–8.2 months ) in CRS and 11.0 months ( 95 % confidence interval 10.0–11.9 months ) in the CRS + HIPEC groups ( P = 0.046 ) . Four patients ( 11.7 % ) in the CRS group and 5 ( 14.7 % ) patients in the CRS + HIPEC group developed serious adverse events ( P = 0.839 ) . Multivariate analysis found CRS + HIPEC , synchronous PC , CC 0–1 , systemic chemotherapy ≥ 6 cycles , and no serious adverse events were independent predictors for better survival . Conclusions For synchronous gastric PC , CRS + HIPEC with mitomycin C 30 mg and cisplatin 120 mg may improve survival with acceptable morbidity 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 The prediction of peritoneal recurrence in gastric cancer patients is extremely important in preventing an unfavorable prognosis . In this prospect i ve study , we examined the usefulness of the carcinoembryonic antigen ( CEA ) and cytokeratin 20 ( CK20 ) mRNA detection in peritoneal washes as a prophylactic tool for peritoneal recurrence . Peritoneal washes were obtained from 164 patients with gastric carcinoma during a laparotomy .  CEA , CK20 and glyceraldehyde-3-phosphate-dehydrogenase mRNA levels in the peritoneal washes were detected by real-time reverse transcription-polymerase chain reaction ( RT-PCR ) using LightCycler . Molecular detection of the CEA and CK20 mRNA in the peritoneal washes by real-time RT-PCR showed a significant correlation with tumor size , histological type , depth of invasion , lymphatic invasion , venous invasion , lymph node metastasis , peritoneal dissemination , stage and cytology . The peritoneal recurrence-free survival and overall survival rates of CEA and CK20 mRNA-positive patients were significantly worse than those of marker gene-negative patients . The CEA and CK20 mRNA levels in the peritoneal washes were a significant independent prognostic factor . In conclusion , our prospect i ve study demonstrates that the detection of CEA and CK20 mRNA by quantitative real-time RT-PCR is a useful tool for identifying patients at high risk of peritoneal recurrence who may need adjuvant chemotherapy 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 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 
    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 Background This r and omized phase III study was to evaluate the efficacy and safety of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) for the treatment of peritoneal carcinomatosis ( PC ) from gastric cancer . Methods Sixty-eight gastric PC patients were r and omized into CRS alone ( n = 34 ) or CRS + HIPEC ( n = 34 ) receiving cisplatin 120 mg and mitomycin C 30 mg each in 6000 ml of normal saline at 43 ± 0.5 ° C for 60–90 min . The primary end point was overall survival , and the secondary end points were safety profiles . Results Major clinicopathological characteristics were balanced between the 2 groups . The PC index was 2–36 ( median 15 ) in the CRS + HIPEC and 3–23 ( median 15 ) in the CRS groups ( P = 0.489 ) . The completeness of CRS score ( CC 0–1 ) was 58.8 % ( 20 of 34 ) in the CRS and 58.8 % ( 20 of 34 ) in the CRS + HIPEC groups ( P = 1.000 ) . At a median follow-up of 32 months ( 7.5–83.5 months ) , death occurred in 33 of 34 ( 97.1 % ) cases in the CRS group and 29 of 34 ( 85.3 % ) cases of the CRS + HIPEC group . The median survival was 6.5 months ( 95 % confidence interval 4.8–8.2 months ) in CRS and 11.0 months ( 95 % confidence interval 10.0–11.9 months ) in the CRS + HIPEC groups ( P = 0.046 ) . Four patients ( 11.7 % ) in the CRS group and 5 ( 14.7 % ) patients in the CRS + HIPEC group developed serious adverse events ( P = 0.839 ) . Multivariate analysis found CRS + HIPEC , synchronous PC , CC 0–1 , systemic chemotherapy ≥ 6 cycles , and no serious adverse events were independent predictors for better survival . Conclusions For synchronous gastric PC , CRS + HIPEC with mitomycin C 30 mg and cisplatin 120 mg may improve survival with acceptable morbidity 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 The prediction of peritoneal recurrence in gastric cancer patients is extremely important in preventing an unfavorable prognosis . In this prospect i ve study , we examined the usefulness of the carcinoembryonic antigen ( CEA ) and cytokeratin 20 ( CK20 ) mRNA detection in peritoneal washes as a prophylactic tool for peritoneal recurrence . Peritoneal washes were obtained from 164 patients with gastric carcinoma during a laparotomy .  CEA , CK20 and glyceraldehyde-3-phosphate-dehydrogenase mRNA levels in the peritoneal washes were detected by real-time reverse transcription-polymerase chain reaction ( RT-PCR ) using LightCycler . Molecular detection of the CEA and CK20 mRNA in the peritoneal washes by real-time RT-PCR showed a significant correlation with tumor size , histological type , depth of invasion , lymphatic invasion , venous invasion , lymph node metastasis , peritoneal dissemination , stage and cytology . The peritoneal recurrence-free survival and overall survival rates of CEA and CK20 mRNA-positive patients were significantly worse than those of marker gene-negative patients . The CEA and CK20 mRNA levels in the peritoneal washes were a significant independent prognostic factor . In conclusion , our prospect i ve study demonstrates that the detection of CEA and CK20 mRNA by quantitative real-time RT-PCR is a useful tool for identifying patients at high risk of peritoneal recurrence who may need adjuvant chemotherapy 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 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 
    Output:
    