Clinical ScienceLocalized pancreatic cancer with positive peritoneal cytology as a sole manifestation of metastatic disease: a single-institution experience

- Patients with pancreatic cancer and positive peritoneal cytology as a sole metastatic site form a unique subset of this disease.
- In our institutional experience, such patients are not associated with long-term disease-free survival, even when chemoradiation is used.
- However, these patients do display improved overall survival compared with our institutional cohort of patients with gross metastatic disease.
- Laparoscopic evaluation for cytology is an important staging tool for all patients with localized pancreatic cancer.

BackgroundPancreatic cancer patients with positive peritoneal cytology (PPC) as a sole metastatic site are poorly characterized. Whether they behave similarly to other stage IV patients is unknown.MethodsPatients with stage IV disease at our institution between 2003 and 2013 were identified. Inclusion criteria for PPC cohort were PPC at laparoscopy and no laparoscopic and/or radiographic evidence of metastasis. Patients with gross metastasis had laparoscopic and/or radiographic evidence of metastasis.ResultsAmong 308 patients, 43 patients had PPC and 265 had gross metastasis. PPC cohort: 3 (7%) resectable, 8 (19%) borderline resectable, and 32 (74%) unresectable tumor. Disease progression occurred in 37 (86%). Sixteen of 43 (37%) also received local therapy (1 surgery and 15 chemoradiation). PPC vs gross metastasis cohort differed as follows: baseline Ca 19-9 (440 vs 1,904 IU/mL, P < .0001); Eastern Cooperative Oncology Group (ECOG) score ≤1 (98 vs 88%, P = .04); median overall survival (13.9 vs 9.4 months, P = .0001).ConclusionsPatients with PPC failed to display long-term disease-free survival, although overall survival was superior compared with those with gross metastasis. Patients with PPC may need to be considered a specific subgroup for staging and survival analysis.