Surgery-Induced Peritoneal Cancer Cells in Patients Who Have Undergone Curative Gastrectomy for Gastric Cancer
Surgery-Induced Peritoneal Cancer Cells in Patients Who Have Undergone Curative Gastrectomy for Gastric Cancer
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DOI：
10.1245/s10434-014-3525-9
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发表时间：
2014-06-01
影响因子：
3.7
通讯作者：
Tani, Tohru
中科院分区：
文献类型：
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作者：
Takebayashi, Katsushi;Murata, Satoshi;Tani, Tohru
有些胃癌患者在接受根治性胃切除术后，会出现腹膜转移。这些转移细胞的来源尚不清楚。102例胃癌患者行根治性胃切除术联合LND。在胃切除术前后收集腹膜冲洗液。细胞学，逆转录-聚合酶链反应和细胞培养被用来确定癌细胞的存在。使用Ki-67染色评价肿瘤细胞的增殖潜力。通过将细胞注射到NOD/ShiJic-scid小鼠的腹腔中来评估致瘤能力。在102例胃切除术前的腹腔冲洗液样本中，57例未检测到CEA或CK 20 mRNA扩增，检测腹膜无复发生存率（RFS）和腹膜复发率（RR）以确定检测到的癌细胞的临床相关性。胃切除术后，CEA或CK 20 mRNA的检测在这57个样本中的35个，并确定在24个活癌细胞。所有24例活癌细胞均显示Ki-67阳性，表明增殖活性。在4例NOD/ShiJic-scid小鼠中，培养的活癌细胞溢出腹膜腔后产生腹膜结节。胃切除术后CEA或CK 20 mRNA扩增的患者的腹膜RFS显著差于阴性扩增的患者（p <0.05）。24例胃切除术后腹腔内有存活癌细胞的患者显示出比无存活癌细胞的患者更高的腹膜RR（p = 0.033）。手术期间，存活的致瘤性癌细胞溢出到腹腔内，表明手术诱导腹膜转移。
Some patients who undergo curative gastrectomy with lymph node dissection (LND) for gastric cancer (GC) show subsequent peritoneal metastasis. The source of these metastatic cells remains unclear.Curative gastrectomy with LND was performed in 102 patients with GC. Peritoneal washing was collected before and after gastrectomy. Cytology, reverse transcription-polymerase chain reaction, and cell culture were used to determine the presence of cancer cells. The proliferative potential of tumor cells was evaluated using Ki-67 staining. Tumorigenic capacity was assessed by cell injection into the peritoneal cavity of NOD/ShiJic-scid mice. Peritoneal recurrence-free survival (RFS) and peritoneal recurrence rate (RR) were examined to determine the clinical relevance of detected cancer cells.Of 102 peritoneal washing samples obtained before gastrectomy, 57 showed no CEA or CK20 mRNA amplification. After gastrectomy, CEA or CK20 mRNA was detected in 35 of these 57 samples, and viable cancer cells were identified in 24. The viable cancer cells in all 24 cases showed Ki-67 positivity, indicating proliferative activity. Cultured viable cancer cells generated peritoneal nodules after spilling over the peritoneal cavity in NOD/ShiJic-scid mice in 4 cases. The peritoneal RFS of patients with CEA or CK20 mRNA amplification after gastrectomy was significantly poorer than that of patients with negative amplification (p < .05). The 24 patients with viable cancer cells in the peritoneal cavity after gastrectomy showed higher peritoneal RR than those without them (p = .033).Viable tumorigenic cancer cells spilled into the peritoneal cavity during surgery, indicating that surgery induces peritoneal metastasis.