Jiangnan University, Wuxi School of Medicine, Wuxi, China.
Affiliated Hospital of Jiangnan University, Department of Oncology, Wuxi, China.
PeerJ. 2024 Jun 28;12:e17602. doi: 10.7717/peerj.17602. eCollection 2024.
Peritoneal metastasis (PM) is the most prevalent type of metastasis in patients with gastric cancer (GC) and has an extremely poor prognosis. The detection of free cancer cells (FCCs) in the peritoneal cavity has been demonstrated to be one of the worst prognostic factors for GC. However, there is a lack of sensitive detection methods for FCCs in the peritoneal cavity. This study aimed to use a new peritoneal lavage fluid cytology examination to detect FCCs in patients with GC, and to explore its clinical significance on diagnosing of occult peritoneal metastasis (OPM) and prognosis.
Peritoneal lavage fluid from 50 patients with GC was obtained and processed the isolation by size of epithelial tumor cells (ISET) method. Immunofluorescence and fluorescence hybridization (FISH) were used to identify FCCs expressing chromosome 8 (CEP8), chromosome 17 (CEP17), and epithelial cell adhesion molecule (EpCAM).
Using a combination of the ISET platform and immunofluorescence-FISH, the detection of FCCs was higher than that by light microscopy (24.0% . 2.0%). Samples were categorized into positive and negative groups, based on the expressions of CEP8, CEP17, and EpCAM. Statistically significant relationships were demonstrated between age ( = 0.029), sex ( = 0.002), lymphatic invasion ( = 0.001), pTNM stage ( = 0.001), and positivity for FCCs. After adjusting for covariates, patients with positive FCCs had lower progression-free survival than patients with negative FCCs.
The ISET platform highly enriched nucleated cells from peritoneal lavage fluid, and indicators comprising EpCAM, CEP8, and CEP17 confirmed the diagnosis of FCCs. As a potential detection method, it offers an opportunity for early intervention of OPM and an extension of patient survival.
腹膜转移（PM）是胃癌（GC）患者最常见的转移类型，预后极差。已证实腹腔游离癌细胞（FCCs）的检测是 GC 预后最差的因素之一。然而，目前缺乏对腹腔 FCCs 的敏感检测方法。本研究旨在采用新的腹腔灌洗液细胞学检查方法检测 GC 患者的 FCCs，并探讨其对隐匿性腹膜转移（OPM）的诊断和预后的临床意义。
收集 50 例 GC 患者的腹腔灌洗液，采用大小分离上皮肿瘤细胞（ISET）法分离。采用免疫荧光和荧光原位杂交（FISH）技术鉴定表达染色体 8（CEP8）、染色体 17（CEP17）和上皮细胞黏附分子（EpCAM）的 FCCs。
采用 ISET 平台联合免疫荧光-FISH 法检测 FCCs 的检出率高于光镜（24.0%，2.0%）。根据 CEP8、CEP17 和 EpCAM 的表达情况，将样本分为阳性组和阴性组。结果显示，年龄（ = 0.029）、性别（ = 0.002）、淋巴浸润（ = 0.001）、pTNM 分期（ = 0.001）与 FCCs 的表达呈显著相关。调整混杂因素后，FCCs 阳性患者的无进展生存期低于 FCCs 阴性患者。
ISET 平台高度富集腹腔灌洗液中的有核细胞，EpCAM、CEP8 和 CEP17 等指标可明确 FCCs 的诊断。作为一种潜在的检测方法，它为 OPM 的早期干预和患者生存的延长提供了机会。
