Li Ziyu, Li Zhemin, Jia Shuqin, Bu Zhaode, Zhang Lianhai, Wu Xiaojiang, Li Shuangxi, Shan Fei, Ji Xin, Ji Jiafu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center for Molecular Diagnostics, Peking University Cancer Hospital & Institute, Beijing 100142, China
Chin J Cancer Res. 2017 Apr;29(2):109-117. doi: 10.21147/j.issn.1000-9604.2017.02.03.
Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis.
Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer (cT≥2M0). We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy, and examined the relationship between peritoneal dissemination (P) and cytology results (CY). Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis. Multivariate logistic regression analysis and receiver-operator characteristic (ROC) analysis were performed in training set to find out risk factors of intra-abdominal metastasis, and then validate it in testing set.
Out of 249 cM0 patients, 51 (20.5%) patients with intra-abdominal metastasis were identified by diagnostic laparoscopy, including 20 (8.0%) P1CY1, 17 (6.8%) P0CY1 and 14 (5.6%) P1CY0 patients. In the training set, multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography (CT) scan ≥21 mm and tumor-occupied ≥2 portions of stomach are predictive factors of metastasis. In the testing set, when diagnostic laparoscopy was performed on patients who had one or two of these risk factors, the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0% and 32.1%, respectively.
According to our results, depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis.
推荐诊断性腹腔镜检查用于胃癌的治疗前分期，以检测任何意外的或未确诊的腹腔内转移。本研究的目的是评估诊断性腹腔镜检查在检测腹腔内转移中的作用和适应证。
对临床诊断为原发性局部进展期胃癌（cT≥2M0）的患者前瞻性地进行标准诊断性腹腔镜检查及腹膜细胞学检查。我们计算了诊断性腹腔镜检查发现的腹腔内转移率，并检查了腹膜播散（P）与细胞学结果（CY）之间的关系。采用拆分样本法寻找腹腔内转移的临床危险因素。在训练集中进行多因素逻辑回归分析和受试者操作特征（ROC）分析以找出腹腔内转移的危险因素，然后在测试集中进行验证。
在249例cM0患者中，诊断性腹腔镜检查发现51例（20.5%）有腹腔内转移，包括20例（8.0%）P1CY1、17例（6.8%）P0CY1和14例（5.6%）P1CY0患者。在训练集中，多因素逻辑回归分析和ROC分析显示，计算机断层扫描（CT）上肿瘤浸润深度≥21 mm且肿瘤占据胃的≥2个部分是转移的预测因素。在测试集中，对有这些危险因素之一或两个的患者进行诊断性腹腔镜检查时，检测腹腔内转移的敏感性和阳性预测值分别为90.0%和32.1%。
根据我们的结果，肿瘤浸润深度和肿瘤占据胃的部分是腹腔内转移的预测因素。
