Benevolo M, Mottolese M, Cosimelli M, Tedesco M, Giannarelli D, Vasselli S, Carlini M, Garofalo A, Natali P G
Regina Elena Cancer Institute, Rome, Italy.
J Clin Oncol. 1998 Oct;16(10):3406-11. doi: 10.1200/JCO.1998.16.10.3406.
Among the clinical factors with a pivotal role in the prediction of outcome for patients with gastric cancer, intraperitoneal (i.p.) microscopic dissemination may represent an important cause of recurrences, even in the early stages of the disease. In this context, the cytologic examination of intraoperative peritoneal washings may be essential to identify metastatic free cells, although a number of false-negative cases may be encountered.
To determine whether immunocytochemical (ICC) methods that used a panel of three monoclonal antibodies (MoAbs), B72.3, AR3, and BD5, directed to gastric cancer-associated antigens can improve peritoneal cytology by providing more accurate prognostic indications, we immunocytochemically and morphologically evaluated 144 peritoneal washings sampled from patients surgically treated for gastric cancer.
The ICC analysis allowed the identification of metastatic free peritoneal cells in 35% of the patients, with a 14% improvement over routine cytopathology (P < .0001). Furthermore, a 54-month survival analysis by Kaplan-Meier curves showed a statistically significant decrease in overall survival (OS) in patients with stages I through III disease with peritoneal microscopic disease detected morphologically and/or by ICC at the time of the primary surgery.
Our data indicate that the use of a combination of selected MoAbs may allow the identification of cytologically false-negative cases that provide valuable prognostic information. This may be useful to stratify patients on more adequate therapeutic trials.
在对胃癌患者预后预测起关键作用的临床因素中，即使在疾病早期，腹腔内微观播散也可能是复发的重要原因。在这种情况下，术中腹腔冲洗液的细胞学检查对于识别转移性游离细胞可能至关重要，尽管可能会遇到一些假阴性病例。
为了确定使用一组针对胃癌相关抗原的三种单克隆抗体（MoAbs）B72.3、AR3和BD5的免疫细胞化学（ICC）方法是否能通过提供更准确的预后指标来改善腹腔细胞学检查，我们对144例接受胃癌手术治疗患者的腹腔冲洗液进行了免疫细胞化学和形态学评估。
ICC分析在35%的患者中识别出了无转移的腹腔细胞，比常规细胞病理学提高了14%（P <.0001）。此外，通过Kaplan-Meier曲线进行的54个月生存分析显示，在初次手术时通过形态学和/或ICC检测到有腹腔微观病变的I至III期疾病患者中，总生存期（OS）有统计学意义的下降。
我们的数据表明，使用选定的MoAbs组合可能有助于识别提供有价值预后信息的细胞学假阴性病例。这对于在更合适的治疗试验中对患者进行分层可能是有用的。
