新辅助化疗前后腹腔游离肿瘤细胞对可治愈性切除的胃癌患者预后的意义。

Prognostic significance of free peritoneal tumor cells in the peritoneal cavity before and after neoadjuvant chemotherapy in patients with gastric carcinoma undergoing potentially curative resection.

机构信息

National Center of Tumor Diseases, University of Heidelberg, Heidelberg, Germany.

出版信息

Ann Surg Oncol. 2010 Oct;17(10):2733-9. doi: 10.1245/s10434-010-1090-4. Epub 2010 May 19.

DOI:10.1245/s10434-010-1090-4

PMID:20490698

Abstract

BACKGROUND

Free peritoneal tumor cells (FPTCs) are an independent prognostic factor in patients undergoing curative resection for gastric carcinoma. Whether neoadjuvant chemotherapy (NAC) can eliminate FPTCs in the peritoneal lavage remains unclear. The aim of the study was to determine the effect of NAC on FPTCs.

METHODS

From 1994 to 2000, data from a total of 61 patients with resectable gastric cancer were analyzed. Peritoneal cytology was performed before NAC at laparoscopy and at tumor resection. A minimum of 6 weeks of NAC, consisting of cisplatin, folinic acid, and fluorouracil, was administered. FPTCs were detected immunohistochemically with Ber-EP4 antibody.

RESULTS

No FPTCs could be detected in 42 patients (69%), compared to 19 (31%) with FPTCs before NAC. During chemotherapy, 10 (24%) of 42 patients developed FPTCs, and 7 (37%) of 19 patients reverted from positive to negative. Patients who became FPTC negative (n = 7) showed an improved median survival (36.1 months) and a longer 2-year survival (71.4%) compared to FPTC-positive patients before and after NAC (n = 12), with a median survival of 9.2 months and a 2-year survival rate of 25%. In contrast, patients who reverted from FPTC negative to positive during NAC (n = 10) had a median survival of 18.5 months and a 2-year survival of only 20%. Multivariate analysis identified ypN category and FPTC change as independent prognostic factors.

CONCLUSIONS

NAC for patients with positive cytology could lead to FPTC negativity in a subset of patients and improve their prognosis. However, NAC might be a risky strategy for almost one-quarter of patients whose disease develops positive cytology.

摘要

背景

游离腹膜肿瘤细胞（FPTCs）是接受胃癌根治性切除术患者的独立预后因素。新辅助化疗（NAC）是否能消除腹膜灌洗液中的 FPTCs 尚不清楚。本研究旨在确定 NAC 对 FPTCs 的影响。

方法

1994 年至 2000 年，分析了 61 例可切除胃癌患者的数据。在腹腔镜检查和肿瘤切除前进行 NAC 前的腹膜细胞学检查。给予至少 6 周的 NAC，包括顺铂、亚叶酸钙和氟尿嘧啶。使用 Ber-EP4 抗体进行 FPTCs 的免疫组织化学检测。

结果

42 例（69%）患者中未检测到 FPTCs，而 NAC 前 19 例（31%）患者中有 FPTCs。在化疗过程中，42 例患者中有 10 例（24%）出现 FPTCs，19 例患者中有 7 例（37%）由阳性转为阴性。从 FPTC 阳性转为阴性的患者（n=7）中位生存期（36.1 个月）和 2 年生存率（71.4%）得到改善，而 NAC 前后的 FPTC 阳性患者（n=12）中位生存期为 9.2 个月，2 年生存率为 25%。相比之下，在 NAC 期间从 FPTC 阴性转为阳性的患者（n=10）中位生存期为 18.5 个月，2 年生存率仅为 20%。多变量分析表明 ypN 分期和 FPTC 变化是独立的预后因素。