Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
ANZ J Surg. 2022 Apr;92(4):794-800. doi: 10.1111/ans.17436. Epub 2022 Jan 11.
Locoregional recurrence after curative resection remains an important issue in the treatment of colorectal cancer (CRC). The aim of the present study was to investigate the clinical significance of quantitative detection of intraperitoneal free cancer cells by a PCR-based method for predicting locoregional recurrence after CRC resection.
A total of 114 patients with CRC were enrolled between March 2017 and December 2018, and 95 patients with Stage I-III CRC were analyzed. Peritoneal lavage fluid was collected before and after tumour resection and subjected to cytology and quantitative reverse transcription-PCR (qRT-PCR) with carcinoembryonic antigen (CEA) as a genetic marker.
2.1% of patients had positive cytology after resection, whereas 9.5% had positive CEA qRT-PCR (PCR+) after resection. Eight of nine PCR+ patients after resection had tumours in the rectum. Fifteen (15.8%) patients developed recurrence during the follow-up period, including three with locoregional recurrence. One of 86 (1.2%) PCR- patients and 2 of 9 (22.2%) PCR+ patients after resection developed locoregional recurrence. Overall and in rectal cancer patients, the 3-year cumulative risk of locoregional recurrence was 25.0% and 28.6% for PCR+ patients, which is significantly higher than PCR- patients (1.3% and 0%, P < 0.001 and P = 0.001, respectively).
Intraperitoneal free cancer cells can serve as a sensitive predictor of locoregional recurrence after rectal cancer resection. qRT-PCR for CEA can be a suitable method for detecting intraperitoneal free cancer cells in peritoneal lavage fluid.
结直肠癌（CRC）根治性切除术后局部区域复发仍然是一个重要问题。本研究旨在探讨基于 PCR 方法定量检测腹腔游离癌细胞对预测 CRC 切除后局部区域复发的临床意义。
2017 年 3 月至 2018 年 12 月期间共纳入 114 例 CRC 患者，其中 95 例为 I-III 期 CRC 患者。在肿瘤切除前后采集腹腔灌洗液，进行细胞学检查和以癌胚抗原（CEA）为遗传标志物的定量逆转录 PCR（qRT-PCR）。
术后有 2.1%的患者细胞学检查阳性，9.5%的患者术后 CEA qRT-PCR 阳性（PCR+）。9 例 PCR+患者中有 8 例为直肠肿瘤。95 例患者中有 15 例（15.8%）在随访期间复发，其中 3 例为局部区域复发。86 例 PCR-患者中有 1 例（1.2%）和 9 例 PCR+患者中有 2 例（22.2%）发生局部区域复发。在总体患者和直肠肿瘤患者中，PCR+患者的 3 年局部区域复发累积风险分别为 25.0%和 28.6%，明显高于 PCR-患者（1.3%和 0%，P<0.001 和 P=0.001）。
腹腔游离癌细胞可作为直肠肿瘤切除术后局部区域复发的敏感预测指标。CEA qRT-PCR 可作为检测腹腔灌洗液中腹腔游离癌细胞的合适方法。
