Lee In Kyu, Kim Do Hyoung, Gorden D Lee, Lee Yoon Suk, Sung Na Young, Park Gyeoung-Sin, Kim Hyung Jin, Kang Won Kyung, Park Jong Kyung, Ahn Chang Hyeok, Kim Jun-Gi, Jeon Hae Myung, Oh Seong Taek
Department of Surgery, College of Medicine, St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Ann Surg Oncol. 2009 Apr;16(4):861-70. doi: 10.1245/s10434-008-0294-3. Epub 2009 Feb 3.
Early diagnosis and management of peritoneal metastases from colorectal cancer patients are difficult clinical challenges. The aims of this study were to evaluate the clinical significance of tumor markers and cytology in peritoneal effusions (PE) and peritoneal irrigation fluid (PI) and to determine their value as prognostic indicators in this disease.
Two hundred thirty-four consecutive patients who underwent abdominal surgery for colorectal cancer from January 2006 to December 2007 were included, and tumor markers and cytology in PE and PI were analyzed prospectively.
The incidence of free cancer cells retrieved from peritoneal samples was 7.9%. Cytology was positive in 40.0% by Papanicolaou and Giemsa staining, 73.3% by hematoxylin and eosin staining of cell blocks, and 66.7% by carcinoembryonic antigen (CEA) and calretinin immunohistochemistry. Multivariate analysis revealed that peritoneal CEA and cancer antigen (CA) 19-9 in PI were correlated with peritoneal metastasis and cytology. Level of peritoneal fluid CEA was statistically significantly correlated with recurrence and peritoneal metastatic recurrence in patients with negative peritoneal cytology. Cytology, peritoneal CEA, and peritoneal CA 19-9 showed correlations with cancer-free survival and overall survival.
These correlations demonstrate the importance of continuous follow-up of peritoneal metastasis if there is positive cytology or an increase in CEA and CA 19-9 in peritoneal fluid.
结直肠癌患者腹膜转移的早期诊断和治疗是临床面临的难题。本研究旨在评估肿瘤标志物及腹水（PE）和腹腔冲洗液（PI）细胞学检查的临床意义，并确定其作为该疾病预后指标的价值。
纳入2006年1月至2007年12月期间连续234例行结直肠癌腹部手术的患者，前瞻性分析PE和PI中的肿瘤标志物及细胞学检查结果。
从腹膜样本中检出游离癌细胞的发生率为7.9%。巴氏染色和吉姆萨染色细胞学阳性率为40.0%，细胞块苏木精-伊红染色阳性率为73.3%，癌胚抗原（CEA）和钙视网膜蛋白免疫组化阳性率为66.7%。多因素分析显示，PI中的腹膜CEA和癌抗原（CA）19-9与腹膜转移及细胞学检查相关。腹膜液CEA水平与腹膜细胞学检查阴性患者的复发及腹膜转移复发在统计学上显著相关。细胞学检查、腹膜CEA和腹膜CA 19-9与无癌生存率和总生存率相关。
这些相关性表明，如果细胞学检查阳性或腹膜液中CEA和CA 19-9升高，持续随访腹膜转移情况具有重要意义。
