Lack of prognostic role of pre- and postoperative peritoneal cytology and cytokeratin PCR-expression on local recurrence after curative anterior resection for mid-low rectal cancer
Lack of prognostic role of pre- and postoperative peritoneal cytology and cytokeratin PCR-expression on local recurrence after curative anterior resection for mid-low rectal cancer
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DOI：
10.1007/s13304-011-0071-x
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发表时间：
2011-06-01
期刊：
影响因子：
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通讯作者：
Rinaldi, Marcella
中科院分区：
文献类型：
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作者：
Altomare, Donato F.;Tedeschi, Michele;Rinaldi, Marcella
局部复发仍然是直肠癌的一个主要问题。癌症切除后，检测存活的癌细胞可能有助于识别有局部复发风险的患者。因此，该研究的目的是检测残留的腹膜癌细胞，其对局部复发可能具有预后作用。 29 名患者因低位（腹膜外）直肠癌接受手术（R0），未接受新辅助放化疗。在癌症切除之前和之后立即进行腹膜灌洗，以通过 RT-PCR 评估分离细胞上的细胞角蛋白 20 mRNA，并通过 Thin-prep 测试检测癌细胞。中位随访 39 个月后，5 名患者死亡（17%），其中 1 名患者死于非癌症相关疾病，2 名患者（7%）死于局部复发和腹膜癌，2 名患者死于远处转移。术前Thin-prep试验细胞学检查阳性4例（14%），术后腹膜细胞学检查仅1例阳性，与以往不同。没有患者出现局部或远端复发，并且在随访结束时所有患者均无疾病。 11 例患者癌切除后腹腔灌洗结果 RT-PCR 分析呈阳性。一人因无关原因死亡，无人出现局部复发。第一次灌洗 RT-PCR 分析呈阳性、第二次灌洗呈阴性的 2 例患者中，仅 1 例发生局部复发。我们的研究表明，薄层制备试验和细胞角蛋白 20 mRNA 的 RTPCR 对于检测直肠癌根治性切除术后局部复发风险患者的预后作用并不重要。
Local recurrence continues to be a major problem in rectal cancer. After cancer removal, detection of viable cancer cells could be useful to identify patients at risk for local recurrence. Thus, aim of the study was the detection of residual peritoneal cancer cells with a possible prognostic role for local recurrence. Twenty-nine patients were operated (R0) for low (extraperitoneal) rectal cancer, without neoadjuvant radiochemotherapy. Before and immediately after cancer removal, a peritoneal lavage was done to evaluate by RT-PCR the cytokeratin 20 mRNA on isolated cells and in order to detect cancer cells by the Thin-prep test. After a median follow-up of 39 months, 5 patients died (17%), one for non-cancer-related disease, two (7%) for local recurrence and peritoneal carcinosis, and two for distant metastases. Preoperative cytology with Thin-prep test was positive in 4 patients (14%), while postoperative peritoneal cytology was positive only in 1 patient, different from the previous. No patient developed local or distal recurrence and all were disease-free at the end of the follow-up. RT-PCR analysis was positive on the peritoneal lavage after cancer removal in 11 patients. One died for unrelated cause and no one developed local recurrences. Local recurrence occurred in only 1 of the 2 patients with positive RT-PCR analysis on the first lavage and negative on the second lavage. Our study demonstrates a not important prognostic role of Thin-prep test and RTPCR of cytokeratin 20 mRNA on the detection of patients at risk for local recurrence after curative resection of rectal cancer.