Yamashita Keishi, Sakuramoto Shinichi, Kikuchi Shiro, Katada Natsuya, Kobayashi Nobuyuki, Watanabe Masahiko
Department of Surgery, Kitasato University Higashi Hospital, Kanagawa, Japan.
Hepatogastroenterology. 2008 Sep-Oct;55(86-87):1873-7.
BACKGROUND/AIMS: Advanced gastric cancer is a disease with dismal prognosis, which is mainly characterized by the emerging intraperitoneal free gastric cancer cells (IFCC). Our interest is to elucidate a causative phenotype linking to IFCC.
Two hundred and sixty-nine resected gastric cancer patients examined for IFCC were enrolled at the Kitasato University Hospital to evaluate the clinical significance of the interaction between IFCC and other tumor phenotypes.
IFCC was not found in the 22 early gastric cancers, and we were thus restricted to evaluate the remaining gastric cancers beyond the muscuralis propria (MP). Among the 247 advanced gastric cancer patients, IFCC was a potent univariate prognostic factor (p<0.0001) as well as lymph node metastasis (P<0.0001), depth of invasion (P=0.0015), and age (P=0.009). IFCC affects poor prognosis more strongly in the modest node disease (n0/n1) than in the severe node disease (n2/n3/M), even after considering D2 dissection. In the modest node disease, multivariate prognostic analysis revealed IFCC as an independent prognostic factor, and lymph node metastasis (n1 against n0 disease) is the only independent predictive tumor factor of IFCC in the logistic regression analysis. As a result, we finally noticed that lymph node metastasis exists in almost advanced gastric cancer with IFCC, while IFCC was hardly detected unless lymph node metastasis exists.
IFCC could be rather strongly associated with lymph node metastasis than depth of invasion in advanced gastric cancer, and transition from the node disease to the peritoneal disease plays a critical role in gastric cancer progression affecting dismal prognosis. Its regulation may be an optimal therapeutic target of advanced gastric cancer.
背景/目的：进展期胃癌预后不良，主要特征是出现腹腔内游离胃癌细胞（IFCC）。我们旨在阐明与IFCC相关的致病表型。
北里大学医院纳入269例接受IFCC检测的胃癌切除患者，以评估IFCC与其他肿瘤表型之间相互作用的临床意义。
22例早期胃癌中未发现IFCC，因此我们仅评估肌层（MP）以外的其余胃癌。在247例进展期胃癌患者中，IFCC是一个有效的单因素预后因素（p<0.0001），淋巴结转移（P<0.0001）、浸润深度（P=0.0015）和年龄（P=0.009）也是如此。即使考虑了D2根治术，IFCC在中度淋巴结疾病（n0/n1）中对预后不良的影响也比在重度淋巴结疾病（n2/n3/M）中更强。在中度淋巴结疾病中，多因素预后分析显示IFCC是一个独立的预后因素，在逻辑回归分析中，淋巴结转移（n1相对于n0疾病）是IFCC唯一独立的预测肿瘤因素。结果，我们最终注意到，几乎所有伴有IFCC的进展期胃癌都存在淋巴结转移，而除非存在淋巴结转移，否则很难检测到IFCC。
在进展期胃癌中，IFCC与淋巴结转移的相关性可能比与浸润深度的相关性更强，从淋巴结疾病向腹膜疾病的转变在影响预后不良的胃癌进展中起关键作用。对其调控可能是进展期胃癌的最佳治疗靶点。
