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Malignant ascites. Clinical and experimental observations.

R N Garrison, L D Kaelin, R H Galloway

    Annals of Surgery
    |June 1, 1986
    PubMed
    Summary

    Malignant ascites, often a poor prognostic sign, was studied in 107 patients. Higher ascitic fluid protein levels correlated with longer survival, suggesting a novel mechanism for fluid accumulation in cancer.

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    Area of Science:

    • Oncology
    • Gastroenterology
    • Pathophysiology

    Background:

    • Malignant ascites is a serious complication of cancer, significantly impacting patient prognosis.
    • Understanding the natural history and underlying mechanisms of malignant ascites is crucial for effective patient management.
    • Current knowledge gaps hinder the selection of optimal therapeutic strategies for patients with malignant ascites.

    Purpose of the Study:

    • To investigate the survival rates of patients with untreated malignant ascites.
    • To identify factors associated with survival in malignant ascites.
    • To elucidate the pathophysiological mechanisms of malignant ascites formation.

    Main Methods:

    • A retrospective review of 107 patients with untreated malignant ascites over a 5-year period.

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  • Analysis of patient demographics, primary tumor types, and ascitic fluid characteristics (cytology, protein content).
  • Experimental validation using a rat model to assess the effect of ascitic fluid on capillary permeability.

    • Main Results:

    • The most common primary tumors were pancreas, ovary, and colon.
    • Ascites was the initial diagnosis in 52% of patients; tumor cells were found in 57% of ascitic fluid samples.
    • Mean survival was 20 weeks, with ovarian and lymphatic cancers showing longer survival (32 and 58 weeks, respectively).
    • Higher ascitic fluid protein levels were associated with improved survival.
    • Experimental models demonstrated that malignant ascites fluid increases capillary permeability, facilitating fluid accumulation.

    Conclusions:

    • Malignant ascites prognosis varies by primary tumor type, with ovarian and lymphatic cancers offering better survival.
    • Elevated ascitic fluid protein levels correlate with improved survival, suggesting a distinct pathophysiological mechanism.
    • Tumor-secreted factors may increase vascular permeability, leading to ascites formation independent of lymphatic obstruction.