Guo Jing, Chen Yongming, Liu Zhimin, Guan Yuanxiang, Wang Wei, Sun Xiaowei, Li Wei, Xu Dazhi
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
J Cancer. 2019 Feb 23;10(6):1489-1495. doi: 10.7150/jca.29814. eCollection 2019.
: Peritoneal metastasis (PM) is the most common cause of death in gastric cancer (GC) patients. However, diagnosis of PM is still difficult in clinical practice. This study aimed to explore the diagnostic and prognostic value of digital rectal examination (DRE) in GC. : 247 GC patients with PM confirmed by operation were included. The diagnostic yield of DRE compared with computed tomography (CT) was calculated. In another group of 1330 cases receiving radical gastrectomy, 38 cases with DRE (+) postoperatively were analyzed to identify risk factors. A nomogram was constructed to predict postoperative DRE (+). : The specificity, positive predictive value and positive likelihood ratio of DRE in diagnosis of PM was 99.8%, 91.2% and 58.4, higher than CT (97.6%, 64.9% and 10.4). Though the sensitivity of DRE (12.6%) was lower than CT (24.7%), 17 of 31 patients with DRE (+) could not be found by CT. Moreover, the overall survival of confirmed PM patients with DRE (+) (PM-DRE (+)) was much lower than PM-DRE (-) patients (P<0.001). In addition, the nomogram to predict postoperative DRE (+) had a bootstrap-corrected concordance index of 0.73 and was well calibrated. : GC patients with DRE (+) could be regarded as a special subtype of stage IV ones with poorer prognosis. Supply of palliative care and chemotherapy rather than unnecessary operation might be a better alternative for these patients. DRE was an effective supplement for CT and should be generally recommended for GC patients.
腹膜转移（PM）是胃癌（GC）患者最常见的死亡原因。然而，在临床实践中，PM的诊断仍然困难。本研究旨在探讨直肠指检（DRE）在GC中的诊断和预后价值。纳入247例经手术确诊为PM的GC患者。计算DRE与计算机断层扫描（CT）相比的诊断阳性率。在另一组1330例行根治性胃切除术的病例中，对术后38例DRE（+）患者进行分析以确定危险因素。构建列线图以预测术后DRE（+）。DRE诊断PM的特异性、阳性预测值和阳性似然比分别为99.8%、91.2%和58.4，高于CT（97.6%、64.9%和10.4）。虽然DRE的敏感性（12.6%）低于CT（24.7%），但31例DRE（+）患者中有17例CT未发现。此外，确诊为PM且DRE（+）（PM-DRE（+））患者的总生存期远低于PM-DRE（-）患者（P<0.001）。此外，预测术后DRE（+）的列线图经自举校正后的一致性指数为0.73，校准良好。DRE（+）的GC患者可被视为预后较差的IV期特殊亚型。对于这些患者，提供姑息治疗和化疗而非不必要的手术可能是更好的选择。DRE是CT的有效补充，应普遍推荐用于GC患者。
