Role of Peritoneal Lavage Cytology and Prediction of Prognosis and Peritoneal Recurrence After Curative Surgery for Colorectal Cancer
Role of Peritoneal Lavage Cytology and Prediction of Prognosis and Peritoneal Recurrence After Curative Surgery for Colorectal Cancer
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DOI：
10.3393/ac.2014.30.6.266
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发表时间：
2014-12-01
影响因子：
3.1
通讯作者：
Park, Sun Hoo
中科院分区：
文献类型：
--
作者：
Bae, Sung Joon;Shin, Ui Sup;Park, Sun Hoo
目的：在结直肠癌中，检测腹腔灌洗液中游离恶性细胞的作用目前尚不清楚。本研究探讨了腹腔灌洗液中游离恶性细胞的阳性率及其对根治性切除术后预后和腹膜复发的预测价值。方法：2009年10月至2011年12月，我们前瞻性地对145例接受结直肠癌根治性手术的患者腹部切口后立即获得的腹腔灌洗液进行细胞学检查。我们使用比例风险回归模型来分析细胞学阳性对腹膜复发和生存的预测作用。结果：在总共 145 名患者中，6 名患者（4.1%）显示细胞学阳性。在中位随访 32 个月（范围为 8-49 个月）期间，27 名患者（18.6%）出现复发。其中，5例（3.4%）出现腹膜癌病。在多变量分析中，阳性细胞学是腹膜复发的独立预测因素（风险比 [HR]，136.5；95% 置信区间 [CI]，12.2-1,531.9；P < 0.0001），也是总生存率的独立不良预后因素（HR，11.4；95% CI，1.8-72.0；P = 0.009）和无病生存率（HR，11.1；95% CI，3.4-35.8；P < 0.0001）。结论：腹膜液细胞学阳性与接受结直肠癌根治性手术的患者的腹膜复发和较差的生存率显着相关。腹膜细胞学检查可能是选择需要腹膜内或全身化疗的患者的有用工具。
Purpose: In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.Methods: From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.Results: Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).Conclusion: Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.