Molecular and genetic parameters of prognosis and new strategies for the treatment of peritoneal carcinomatosis in gastric cancer

Despite advances in modern oncology, in Russia, 36% of gastric cancers are detected at an advanced stage, with a one-year mortality rate of 39.6%. One of the most common causes of death from gastric cancer is peritoneal carcinomatosis. Synchronous peritoneal carcinomatosis is diagnosed in 18–26% of cases. Metachronous carcinomatosis occurs in 7–39% of patients 8.5–26 months after the primary tumor is removed. To date, there are no effective treatments for peritoneal carcinomatosis. Tumors accompanied by peritoneal carcinomatosis are often resistant to systemic chemotherapy. Cytoreductive surgeries and intraperitoneal chemotherapy are not always possible or successful for all patients.
This review focuses on analyzing the molecular and genetic mechanisms of peritoneal carcinomatosis in gastric cancer and presents an original hypothesis suggesting that peritoneal carcinomatosis occurs when tumor cells acquire the ability to autonomously exist in a matrix-independent state in the ascitic fluid without undergoing apoptosis (anoeucsis). Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 10,025 scientific papers were identified, of which 228 English-language and 323 Russian-language publications met the analysis criteria. Twenty-nine articles (including four Russian-language ones) relevant to the topic of this review were included in the review. It is assumed that the identification of key molecules associated with the matrixindependent existence of tumor cells could serve as the basis for the development of technologies for predicting peritoneal carcinomatosis, as well as for the development of new targeted therapy for metastatic gastric cancer.

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