Detection of micrometastases in peritoneal washings of gastric cancer patients by the reverse transcriptase polymerase chain reaction
Detection of micrometastases in peritoneal washings of gastric cancer patients by the reverse transcriptase polymerase chain reaction
复制标题
DOI：
10.1007/s10120-008-0483-6
复制
发表时间：
2008-12-01
期刊：
影响因子：
7.4
通讯作者：
Coit, Daniel G.
中科院分区：
文献类型：
--
作者：
Dalal, Kimberly Moore;Woo, Yanghee;Coit, Daniel G.
腹膜细胞学阳性（+）的胃癌患者的预后与IV期患者相似。我们研究了定量逆转录酶聚合酶链反应 (RT-PCR) 检测分期腹腔镜检查患者腹膜微转移的能力。前瞻性地从 34 名接受分期腹腔镜检查的胃腺癌患者和 6 名接受良性疾病腹腔镜检查的患者获取腹膜冲洗液。每个样本均经过细胞学和 RTPCR 分析肿瘤标志物：癌胚抗原 (CEA)、细胞角蛋白 20 (CK20)、生存素和 MUC2。根据与理想标记物的偏差来评估标记物。胃癌患者的病理分期为：I期，9期（27%）；I期，9期（27%）；第二阶段，7（21%）； III 期，15 例（44%）；和第四阶段，3 (9%)。 4 名细胞学 (+) 患者为：II 期，1；第三阶段，1； IV期，2。15名患者RTPCR（+），包括所有细胞学（+）患者。根据受试者工作特征曲线，循环扩增的最佳阈值是 35。 CEA 的偏差最小。RT-PCR 使用一组肿瘤标志物（包括 CEA）检测 (+) 细胞学。 CEA、生存素或 CK20 的“假阳性”过度表达的临床意义，但细胞学 (-) 仍有待定义。 RT-PCR 可能是一种比细胞学更灵敏的检测亚临床腹膜肿瘤播散的方法；这可能有助于改善手术管理和临床试验的患者选择。
Gastric cancer patients with positive (+) peritoneal cytology have a prognosis similar to stage IV patients. We studied the ability of quantitative reverse transcriptase polymerase chain reaction (RT-PCR) to detect peritoneal micrometastases in patients undergoing staging laparoscopy.Peritoneal washings were obtained prospectively from 34 patients with gastric adenocarcinoma undergoing staging laparoscopy and 6 patients undergoing laparoscopy for benign disease. Each sample underwent cytologic and RTPCR analysis for tumor markers: carcinoembryonic antigen (CEA), cytokeratin 20 (CK20), survivin, and MUC2. Markers were evaluated on the basis of their deviance from the ideal marker.Pathologic stages for the gastric cancer patients were: stage I, 9 (27%); stage II, 7 (21%); stage III, 15 (44%); and stage IV, 3 (9%). The four cytology (+) patients were: stage II, 1; stage III, 1; and stage IV, 2. Fifteen patients were RTPCR (+), including all cytology (+) patients. The optimal threshold for cycle amplification was 35, based on a receiver operating characteristic curve. CEA had the smallest deviance.RT-PCR using a panel of tumor markers, including CEA, detects (+) cytology. The clinical significance of "false-positive" overexpression of CEA, survivin, or CK20 but cytology (-) remains to be defined. RT-PCR could represent a more sensitive method than cytology for detection of subclinical peritoneal tumor dissemination; this may be useful in improving patient selection for operative management and clinical trials.