II期和III期结直肠癌根治性切除患者的腹腔灌洗细胞学检查：一项多机构前瞻性研究。
Peritoneal lavage cytology in patients with curative resection for stage II and III colorectal cancer: A multi-institutional prospective study.
作者信息
Kobayashi Hirotoshi, Kotake Kenjiro, Maeda Kotaro, Suto Takeshi, Kawasaki Masayasu, Ueno Hideki, Komori Koji, Ozawa Heita, Koda Keiji, Ohue Masayuki, Funahashi Kimihiko, Takemasa Ichiro, Ishida Hideyuki, Kazama Shinsuke, Shimada Yoshifumi, Morohashi Hajime, Kinugasa Yusuke, Kanemitsu Yukihide, Ochiai Hiroki, Ishihara Soichiro, Itabashi Michio, Sugihara Kenichi, Ajioka Yoichi
机构信息
Department of Surgery Tokyo Metropolitan Hiroo Hospital Tokyo Japan.
Department of Surgery Teikyo University Hospital Mizonokuchi Kanagawa Japan.
出版信息
Ann Gastroenterol Surg. 2024 May 27;8(5):807-816. doi: 10.1002/ags3.12825. eCollection 2024 Sep.
AIM
To clarify the usefulness of intraoperative lavage cytology in patients undergoing curative resection for pStage II-III colorectal cancer in a prospective multicenter study.
METHODS
Patients preoperatively diagnosed with stage II-III colorectal cancer between 2013 and 2017 from 20 hospitals were enrolled. Lavage cytology was performed twice during the surgery. The primary endpoint was the effect of lavage cytology on the 5-year relapse-free survival (RFS) in patients with pStage II-III colorectal cancer. The secondary endpoint was the effect of lavage cytology on the 5-year overall survival (OS) and peritoneal recurrence.
RESULTS
A total of 1378 patients were eligible for analysis. The number of patients with pStage II-III colorectal cancer was 670 and 708, respectively. Fifty-four patients (3.9%) had positive cytological results. In pStage II patients, the 5-year RFS rates with positive and negative cytology were 61.1% and 81.6%, respectively ( = 0.023). The 5-year OS rates were 67.1% and 91.7%, respectively ( = 0.0083). However, there was no difference in RFS or OS between pStage III patients with positive and negative cytology results. The peritoneal recurrence rates were 11.8% and 1.5% in pStage II patients with positive and negative cytology results, respectively ( = 0.032). These rates were 10.5% and 2.5% in patients with stage III disease, respectively ( = 0.022).
CONCLUSION
Stage II colorectal cancer patients with negative cytology had better outcomes than those with positive cytology. Peritoneal lavage cytology is useful for predicting peritoneal recurrence after curative resection of stage II-III colorectal cancer.
目的
在一项前瞻性多中心研究中，阐明术中灌洗细胞学检查对接受根治性切除术的Ⅱ-Ⅲ期结直肠癌患者的有用性。
方法
纳入2013年至2017年间来自20家医院术前诊断为Ⅱ-Ⅲ期结直肠癌的患者。手术期间进行两次灌洗细胞学检查。主要终点是灌洗细胞学检查对Ⅱ-Ⅲ期结直肠癌患者5年无复发生存率（RFS）的影响。次要终点是灌洗细胞学检查对5年总生存率（OS）和腹膜复发的影响。
结果
共有1378例患者符合分析条件。Ⅱ-Ⅲ期结直肠癌患者分别为670例和708例。54例患者（3.9%）细胞学检查结果为阳性。在Ⅱ期患者中，细胞学检查阳性和阴性的5年RFS率分别为61.1%和81.6%（P=0.023）。5年OS率分别为67.1%和91.7%（P=0.0083）。然而，细胞学检查结果阳性和阴性的Ⅲ期患者在RFS或OS方面没有差异。Ⅱ期患者细胞学检查阳性和阴性的腹膜复发率分别为11.8%和1.5%（P=0.032）。Ⅲ期疾病患者的这些比率分别为10.5%和2.5%（P=0.022）。
结论
细胞学检查阴性的Ⅱ期结直肠癌患者比阳性患者预后更好。腹膜灌洗细胞学检查有助于预测Ⅱ-Ⅲ期结直肠癌根治性切除术后的腹膜复发。
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