Tokuda Koki, Natsugoe Shoji, Nakajo Akihiro, Miyazono Futoshi, Ishigami Sumiya, Hokita Shuichi, Takao Sonshin, Eizuru Yoshito, Aikou Takashi
First Department of Surgery, Kagoshima University School of Medicine, Kagoshima 890-8520, Japan.
Int J Mol Med. 2003 Jan;11(1):79-84.
Peritoneal dissemination is one of the most common modes of gastric cancer recurrence even after curative resection. Cytological examination of peritoneal lavage fluid is useful for detection of free cancer cells in the peritoneal cavity. However, some patients with negative cytological findings have peritoneal metastases of their gastric cancer. The purpose of the present study was to investigate the incidence and clinical significance of metastases harbored in the peritoneal cavity of patients with gastric carcinoma. Peritoneal lavage fluid was collected from the left subphrenic or Douglas cavities of 136 gastric cancer patients without macroscopic peritoneal metastases and 31 patients with benign disease. Peritoneal lavage fluid was examined by both conventional cytological examination (Papanicolaou and Giemsa staining), and carcinoembryonic antigen (CEA)-specific reverse transcription-polymerase chain reaction (RT-PCR). Among 136 gastric cancer patients, 5 patients (3.6%) were positive for free cancer cells by cytological examination and 30 (22.1%) were positive by RT-PCR. A difference in positivity between the left subphrenic and Douglas cavity was found in 18 patients by RT-PCR. The frequency of RT-PCR results increased according to lymph node metastases, lymphatic invasion, depth of tumor invasion and stage grouping. The incidence of peritoneal recurrence was significantly higher in patients with positivity than those with negativity by RT-PCR (p<0.0001). Among cytologically negative patients, survival was significantly shorter in patients with positive than in those with negative CEA-mRNA expression (p<0.0001). The technique of RT-PCR was more sensitive than cytological examination in the detection of cancer cells and prediction of peritoneal recurrence. Adjuvant therapy may be advisable for the gastric cancer patients with positive findings of peritoneal lavage by RT-PCR.
即使在根治性切除术后，腹膜播散仍是胃癌复发最常见的方式之一。腹腔灌洗液体细胞检查有助于检测腹腔内游离癌细胞。然而，一些细胞学检查结果为阴性的患者仍有胃癌腹膜转移。本研究的目的是调查胃癌患者腹腔内转移的发生率及其临床意义。收集了136例无肉眼可见腹膜转移的胃癌患者和31例良性疾病患者左膈下或Douglas腔的腹腔灌洗液体。通过传统细胞学检查（巴氏染色和吉姆萨染色）以及癌胚抗原（CEA）特异性逆转录聚合酶链反应（RT-PCR）对腹腔灌洗液体进行检测。在136例胃癌患者中，5例（3.6%）细胞学检查发现游离癌细胞呈阳性，30例（22.1%）RT-PCR检测呈阳性。RT-PCR检测发现18例患者左膈下腔和Douglas腔的阳性率存在差异。RT-PCR检测结果的阳性率随淋巴结转移、淋巴管浸润、肿瘤浸润深度和分期分组而增加。RT-PCR检测呈阳性的患者腹膜复发发生率显著高于阴性患者（p<0.0001）。在细胞学检查阴性的患者中，CEA-mRNA表达阳性的患者生存期明显短于阴性患者（p<0.0001）。在检测癌细胞和预测腹膜复发方面，RT-PCR技术比细胞学检查更敏感。对于RT-PCR检测腹腔灌洗呈阳性结果的胃癌患者，辅助治疗可能是可取的。
