Detection of disseminated cancer cells in linitis plastica-type gastric carcinoma
Detection of disseminated cancer cells in linitis plastica-type gastric carcinoma
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DOI：
10.1093/jjco/hyh097
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发表时间：
2004-09-01
影响因子：
2.4
通讯作者：
Nakao, A
中科院分区：
文献类型：
--
作者：
Kodera, Y;Nakanishi, H;Nakao, A
背景：癌细胞在腹膜腔内的扩散可能导致腹膜癌病，这是一种常见的肿瘤性肠炎类型的胃癌。逆转录聚合酶链式反应(RT-PCR)是检测这些细胞的一种敏感技术。方法：连续47例可塑性支气管炎患者在开腹手术中获取腹膜冲洗液，这些患者术前被认为是需要根治性切除的对象。结合常规的巴氏染色细胞学检查，实时荧光RT-PCR被用来定量这些洗涤液中的癌胚抗原(CEA)mRNA。结果：常规细胞学检查阳性率为43%(20/47)。CEA mRNA阳性率高达83%(39/47)，腹膜癌实际发生率为77%(36/47)，无论是开腹手术还是术后随访。虽然8例CEA mRNA阴性的患者中只有2例发生腹膜癌，但另有3例患者死于其他转移途径的复发。多因素分析显示，手术的可治愈性(排除CEA信使核糖核酸的值)和T分类是唯一有意义的独立预后因素。结论：腹膜冲洗液的RT-PCR作为预后因素价值不大，但在计划根治性手术的患者中，超过80%的患者腹膜腔内有播散性癌细胞。几乎相同比例的患者实际上患有腹膜癌病。这些事实表明，为什么仅通过手术治疗很少治愈塑化性线炎患者。
Background: Dissemination of cancer cells in the abdominal cavity may lead to peritoneal carcinomatosis, a common event in the linitis plastica type of gastric carcinoma. Reverse transcriptase polymerase chain reaction (RT-PCR) is a sensitive technique for detecting these cells.Methods: Peritoneal washings were obtained during laparotomy from 47 consecutive linitis plastica patients who preoperatively were considered candidates for curative resection. Together with conventional cytological examination using Papanicolaou staining, real-time RT-PCR was performed to quantitate prospectively carcinoembryonic antigen (CEA) mRNA in these washings. Samples above a cutoff value for CEA mRNA were considered positive for molecular detection of disseminated cancer cells.Results: Conventional cytological examination was positive in 43% (20/47). Positivity of CEA mRNA was much higher at 83% (39/47) and peritoneal carcinomatosis actually was observed in 77% (36/47), either at laparotomy or during postoperative follow-up. Although only two of eight patients who were negative for CEA mRNA suffered from peritoneal carcinomatosis, three more patients died of recurrences through other metastatic pathways. Multivariate analysis revealed that curability of the operation (knowledge of the CEA mRNA values excluded) and T categories were the only significant independent prognostic factors.Conclusions: RT-PCR of the peritoneal washes had little value as a prognostic factor, but identified over 80% of the patients planned for curative surgery to have disseminated cancer cells in the peritoneal cavity. Almost the same proportion of patients actually suffered from peritoneal carcinomatosis. These facts indicate why treatment with surgery alone rarely cures patients with linitis plastica.