The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection
The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection
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DOI：
10.1245/aso.2005.03.065
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发表时间：
2005-05-01
影响因子：
3.7
通讯作者：
Coit, D
中科院分区：
文献类型：
--
作者：
Bentrem, D;Wilton, A;Coit, D
背景资料：虽然腹膜细胞学阳性与预后不良相关，但在切除后病理T和N分期的背景下进行评估时，尚未发现其独立预测预后。本研究的目的是评估细胞学阳性的预测价值，在手术前接受胃癌R 0切除术的患者的其他预后因素的背景下，评估其在选择患者进行手术切除术前适当治疗中的作用。方法：从1993年至2003年，在纪念斯隆-凯特琳癌症中心接受胃腺癌R 0切除术的所有患者的临床变量2002年从一个前瞻性的数据库进行了审查。患者术前通过CT扫描、腹腔镜、内窥镜和/或腹腔镜超声评估T和N分期。结果：371例胃癌患者行腹腔镜R 0切除术，腹腔冲洗分期，24例（6.5%）患者腹腔细胞学检查阳性。细胞学阳性与晚期T分期相关（P = 0.02），但与淋巴结阳性无关（P = 0.11）。细胞学阳性患者的中位生存期为14.8个月，细胞学阴性患者的中位生存期为98.5个月（P < 0.001）。多变量分析确定术前T分期、术前N分期、部位和细胞学是预后的重要预测因素。细胞学检查阳性是胃癌死亡的术前预测因素（RR 2.7，P < 0.001）。结论：细胞学检查阳性是胃癌根治性切除术后早期复发和死亡的高危人群的术前信息。
Background: Although positive peritoneal cytology is associated with poor prognosis, it has not been found to be independently predictive of outcome when evaluated in context of post-resection pathologic T and N stage. This study was undertaken to evaluate the predictive value of positive cytology in context of other prognostic factors available prior to surgery in patients undergoing R0 resection for gastric cancer, to assess its role in selecting patients for appropriate treatment prior to surgical resection.Methods: Clinical variables for all patients undergoing R0 resection for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1993-2002 were reviewed from a prospective database. Patients underwent preoperative assessment of T and N stage with CT scan, laparoscopy, and endoscopic and/or laparoscopic ultrasound. Peritoneal cytology was obtained in all patients.Results: Patients with gastric cancer (n = 371) underwent R0 resection and staging laparoscopy with peritoneal washings; 24 patients (6.5%) had positive peritoneal cytology. Positive cytology was associated with advanced T stage (P = 0.02) but not with nodal positivity (P = 0.11). Median survival of patients with positive cytology was 14.8 months vs. 98.5 months for patients with negative cytology (P < 0.001). Multivariate analysis identified preoperative T stage, preoperative N stage, site, and cytology as significant predictors of outcome. Positive cytology was the preoperative factor most predictive of death from gastric cancer (RR 2.7, P < 0.001).Conclusions: Positive cytology is information potentially available preoperatively that identifies a patient population at very high risk for early recurrence and death after curative resection of gastric cancer.