Prognostic Value of Peritoneal Cytology and the Combination of Peritoneal Cytology and Peritoneal Dissemination in Colorectal Cancer
Prognostic Value of Peritoneal Cytology and the Combination of Peritoneal Cytology and Peritoneal Dissemination in Colorectal Cancer
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DOI：
10.1007/dcr.0b013e3181b4c46e
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发表时间：
2009-12-01
影响因子：
3.9
通讯作者：
Nagawa, Hirokazu
中科院分区：
文献类型：
--
作者：
Nishikawa, Takeshi;Watanabe, Toshiaki;Nagawa, Hirokazu
目的：腹膜细胞学阳性在结直肠癌中的价值一直存在争议。在这项研究中，我们的目的是澄清腹膜细胞学的预后意义和腹膜传播和腹膜细胞学的联合对结直肠癌预后评估的影响。方法：从1997年1月至2005年12月，对410例至少有浆膜浸润的患者进行术中腹膜细胞学检查。31例患者（7.6%）的腹膜细胞学检查阳性。细胞学阴性患者的5年生存率显著高于细胞学阳性患者（细胞学阴性68.0%;细胞学阳性20.6%; P < 0.0001）。多因素分析显示腹腔细胞学检查是影响预后的重要因素之一。细胞学阳性者60%复发，细胞学阴性者30.4%复发（P = 0.08）。关于复发部位，细胞学阳性患者的腹膜播散复发率显著高于细胞学阴性患者（P = 0.0038）。部分细胞学阳性但无明显腹膜播散的患者获得长期生存。此外，一些肉眼可见腹膜播散和腹膜细胞学阴性的患者也获得了长期生存。但对于那些阳性细胞学和明显的宏观腹膜传播的患者，5年生存率为零。结论：腹膜细胞学阴性的患者有一个显着更好的5年生存率比那些阳性的腹膜细胞学。在某些情况下，无论是腹膜细胞学或腹膜传播是阴性的，可以实现长期生存。
PURPOSE: The value of positive peritoneal cytology in colorectal cancer has been controversial. In this study, we aimed to clarify the prognostic significance of peritoneal cytology and the impact of the combination of peritoneal dissemination and peritoneal cytology on the prognostic evaluation of colorectal cancer.METHODS: From January 1997 to December 2005, intraoperative peritoneal cytology was performed on 410 patients who had at least serosal invasion.RESULTS: Thirty-one patients (7.6%) had positive peritoneal cytology. Patients with negative cytology showed a significantly better survival rate at five years than those with positive cytology (negative cytology, 68.0%; positive cytology, 20.6%; P < 0.0001). Multivariate analysis revealed that peritoneal cytology is one of the significant prognostic factors. Sixty percent of patients with positive cytology and 30.4% of patients with negative cytology recurred (P = 0.08). Regarding the recurrence site, patients with positive cytology showed a significantly higher recurrence rate of peritoneal dissemination than those with negative cytology (P = 0.0038). Some patients with positive cytology but without evident peritoneal dissemination achieved long-term survival. Additionally, some patients with macroscopic peritoneal dissemination and negative peritoneal cytology also achieved long-term survival. But for those patients with both positive cytology and evident macroscopic peritoneal dissemination, the five-year survival rate was zero.CONCLUSIONS: Patients with negative peritoneal cytology had a significantly better five-year survival rate than those with positive peritoneal cytology. In some cases in which either peritoneal cytology or peritoneal dissemination was negative, long-term survival could be achieved.