Gęca Katarzyna, Rawicz-Pruszyński Karol, Mlak Radosław, Sędłak Katarzyna, Skórzewska Magdalena, Pelc Zuzanna, Małecka-Massalska Teresa, Polkowski Wojciech P
Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland.
Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland.
J Clin Med. 2021 Nov 10;10(22):5230. doi: 10.3390/jcm10225230.
The presence of peritoneal free cancer cells (FCC) in gastric cancer (GC) patients is a poor prognostic factor. D2 gastrectomy may induce exfoliated FCC spread from the primary tumour or involved lymph nodes (LN). Conventional cytology for FCC detection has several limitations, whereas prophylactic use of extensive intraoperative peritoneal lavage (IPL) does not improve survival. A prospective single-arm observational study was conducted to verify whether D2 gastrectomy causes an intraoperative increase of FCC in peritoneal fluid. Twenty-seven GC patients underwent D2 gastrectomy, followed by objective quantitative measurements of CK19 mRNA level reflecting FCC with One-Step Nucleic Acid Amplification (OSNA) assay. The IPL with 3000 mL of saline was performed twice: (1) after gastrectomy with D2 lymphadenectomy and (2) after alimentary tract reconstruction. The IPL samples were analysed by initial cytology and four (1-4) consecutive OSNA assays. Initial OSNA measurement (1) revealed positive results (≥24.6 cCP/μL) in 7 (29.6%) patients. Subsequent OSNA measurements showed a significant decrease in the FCC level after D2 gastrectomy (1 vs. 2; = 0.0012). The first IPL induced a non-significant increase in the FCCs (2 vs. 3, = 0.3300), but the second IPL reversed it to normal levels (3 vs. 4, = 0.0.0574). The OSNA assay indicates a temporal intraoperative increase in the peritoneal FCC in advanced GC patients undergoing D2 gastrectomy. Two consecutive IPLs are necessary to reverse the increase of CK19 mRNA level in peritoneal washings.
胃癌（GC）患者腹腔游离癌细胞（FCC）的存在是一个不良预后因素。D2根治性胃切除术可能会导致FCC从原发肿瘤或受累淋巴结（LN）脱落播散。用于检测FCC的传统细胞学方法有若干局限性，而预防性广泛术中腹腔灌洗（IPL）并不能提高生存率。开展了一项前瞻性单臂观察性研究，以验证D2根治性胃切除术是否会导致术中腹腔液中FCC增加。27例GC患者接受了D2根治性胃切除术，随后采用一步核酸扩增（OSNA）检测法对反映FCC的CK19 mRNA水平进行客观定量测量。用3000 mL生理盐水进行两次IPL：（1）在D2淋巴结清扫的胃切除术后，以及（2）消化道重建术后。通过初始细胞学检查和四次（1 - 4）连续的OSNA检测对IPL样本进行分析。初始OSNA测量（1）显示7例（29.6%）患者结果为阳性（≥24.6 cCP/μL）。随后的OSNA测量显示，D2根治性胃切除术后FCC水平显著下降（1对2；P = 0.0012）。首次IPL使FCC有不显著增加（2对3，P = 0.3300），但第二次IPL将其恢复至正常水平（3对4，P = 0.0574）。OSNA检测表明，接受D2根治性胃切除术的进展期GC患者术中腹腔FCC有一过性增加。需要连续两次IPL才能逆转腹腔冲洗液中CK19 mRNA水平的升高。
