Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Molecular Oncology and Therapeutics, Osaka City University Graduate School of Medicine, Osaka, Japan.
PLoS One. 2020 Jan 15;15(1):e0225958. doi: 10.1371/journal.pone.0225958. eCollection 2020.
Peritoneal recurrence is one of the most frequent recurrent diseases in gastric cancer. Although the exposure of cancer cells to the serosal surface is considered a common risk factor for peritoneal recurrence, there are some cases of peritoneal recurrence without infiltration to the serosal surface even after curative surgery. This study sought to clarify the risk factors of peritoneal recurrence in the absence of invasion to the serosal surface.
Ninety-six patients with gastric cancer who underwent curative surgery were enrolled. In all 96 cases, the depth of tumor invasion was subserosal (T3). The microscopic distance from the tumor invasion front to the serosa (DIFS) was measured using tissue slides by H&E staining and pan-cytokeratin staining. E-cadherin expression was evaluated by immunohistochemical staining.
Among the 96 patients, 16 developed peritoneal recurrence after curative surgery. The DIFS of the tumors with peritoneal recurrence (156±220 μm) was significantly shorter (p = 0.011) than that without peritoneal recurrence (360±478 μm). Peritoneal recurrence was significantly correlated with DIFS ≤234 μm (p = 0.023), but not with E-cadherin expression. The prognosis of DIFS ≤234 μm was significantly poorer than that of DIFS >234 μm (log rank, p = 0.007). A multivariate analysis of the patients' five-year overall survival revealed that DIFS ≤234 μm and lymph node metastasis were significantly correlated with survival (p = 0.005, p = 0.032, respectively).
The measurement of the DIFS might be useful for the prediction of peritoneal recurrence in T3-gastric cancer patients after curative surgery.
腹膜复发是胃癌最常见的复发疾病之一。尽管癌细胞暴露于浆膜表面被认为是腹膜复发的一个常见危险因素，但有些病例即使在根治性手术后也没有侵犯浆膜表面而发生腹膜复发。本研究旨在阐明无浆膜侵犯的腹膜复发的危险因素。
纳入 96 例接受根治性手术的胃癌患者。所有 96 例患者的肿瘤浸润深度均为浆膜下（T3）。使用 H&E 染色和泛细胞角蛋白染色的组织切片测量肿瘤侵犯前缘至浆膜的微观距离（DIFS）。通过免疫组织化学染色评估 E-钙黏蛋白表达。
96 例患者中，16 例在根治性手术后发生腹膜复发。腹膜复发肿瘤的 DIFS（156±220 μm）明显短于无腹膜复发肿瘤的 DIFS（360±478 μm）（p=0.011）。腹膜复发与 DIFS≤234 μm显著相关（p=0.023），但与 E-钙黏蛋白表达无关。DIFS≤234 μm 的预后明显差于 DIFS>234 μm（对数秩，p=0.007）。对患者五年总生存率的多因素分析显示，DIFS≤234 μm 和淋巴结转移与生存率显著相关（p=0.005，p=0.032）。
DIFS 的测量可能有助于预测根治性手术后 T3 期胃癌患者的腹膜复发。
