Fujiwara Yoshiyuki, Okada Kaoru, Hanada Hiroyuki, Tamura Shigeyuki, Kimura Yutaka, Fujita Jyunya, Imamura Hiroshi, Kishi Kentaro, Yano Masahiko, Miki Hirohumi, Okada Kazuyuki, Takayama O, Aoki Taro, Mori Masaki, Doki Yuichiro
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Surgery. 2014 Mar;155(3):417-23. doi: 10.1016/j.surg.2013.10.004. Epub 2013 Oct 11.
We have developed a novel molecular method of diagnosis using the technique of transcriptase-reverse transcriptase concerted reaction (TRC) for the detection of cancer micrometastasis. This study prospectively examined the clinical importance of the TRC diagnosis with peritoneal lavage fluids collected from gastric cancer operations at multiple institutes.
TRC amplification targeting carcinoembryonic antigen mRNA was applied to detect gastric cancer cells in peritoneal lavage fluids obtained during gastric cancer resections from nine different hospitals. A total of 137 patients with a clinical diagnosis of serosa-invading neoplasms were enrolled to investigate the correlation between the TRC diagnosis and patient prognosis.
Of the 137 patients, 27 (20%) were positive by cytologic examination. In contrast, TRC targeting carcinoembryonic antigen mRNA was positive in 59 of 137 (54%) patients. TRC positivity was associated with a poorer overall survival in all patients and in the 104 patients who underwent a curative operation. TRC positivity also was associated with the peritoneal recurrence-free survival rate in the 104 curative cases. Multivariate analysis showed that TRC positivity and the pathologic N factor were prognostic factors for the overall survival time.
Our prospective multicenter study showed that the TRC test using peritoneal lavage fluids could be a potential prognostic factor to predict patient survival and peritoneal recurrence with clinically diagnosed, serosa-invading gastric cancer.
我们开发了一种新型分子诊断方法，利用转录酶 - 逆转录酶协同反应（TRC）技术检测癌症微转移。本研究前瞻性地探讨了TRC诊断在多个机构收集的胃癌手术腹腔灌洗液中的临床重要性。
应用针对癌胚抗原mRNA的TRC扩增来检测从九家不同医院的胃癌切除术中获得的腹腔灌洗液中的胃癌细胞。共有137例临床诊断为浆膜侵犯性肿瘤的患者被纳入研究，以调查TRC诊断与患者预后之间的相关性。
137例患者中，27例（20%）经细胞学检查呈阳性。相比之下，针对癌胚抗原mRNA的TRC在137例患者中的59例（54%）呈阳性。TRC阳性与所有患者以及104例接受根治性手术的患者的总体生存率较差相关。TRC阳性也与104例根治性病例的无腹膜复发生存率相关。多变量分析表明，TRC阳性和病理N因子是总体生存时间的预后因素。
我们的前瞻性多中心研究表明，使用腹腔灌洗液进行TRC检测可能是预测临床诊断为浆膜侵犯性胃癌患者生存和腹膜复发的潜在预后因素。
