Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer

Background: The relationship between ascites, as detected by preoperative computed tomography (CT), and peritoneal metastasis of gastric cancer requires clarification because of its likely significance for clinical outcome. Methods: A retrospective analysis of 293 patients with advanced gastric cancer investigated the association between preoperative CT findings of ascites and surgical findings of peritoneal washing cytology and peritoneal metastasis. Results: Forty-five of 293 patients (15%) presented with ascites on preoperative CT. Positive ascites on CT predicted the presence of free tumor cells with 40% sensitivity and 97% specificity, and peritoneal metastasis with 51% sensitivity and 97% specificity. Ascites on CT was an independent prognostic factor by univariate (P < .001) and multivariate (relative risk, 2.03; 95% confidence interval, 1.39-2.96; P < .001) analyses. The median survival time was 6.0 months in patients with positive ascites on CT. Conclusions: The presence of ascites on CT suggests the presence of peritoneal metastasis and indicates a poor prognosis. The presence of peritoneal metastasis should be confirmed by diagnostic laparoscopy in gastric cancer patients with ascites. (c) 2006 Excerpta Medica Inc. All rights reserved.