Viable Cancer Cells in the Remnant Stomach are a Potential Source of Peritoneal Metastasis after Curative Distal Gastrectomy for Gastric Cancer
Viable Cancer Cells in the Remnant Stomach are a Potential Source of Peritoneal Metastasis after Curative Distal Gastrectomy for Gastric Cancer
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DOI：
10.1245/s10434-016-5219-y
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发表时间：
2016-09-01
影响因子：
3.7
通讯作者：
Tani, Masaji
中科院分区：
文献类型：
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作者：
Murata, Satoshi;Yamamoto, Hiroshi;Tani, Masaji
胃癌（GC）根治性胃切除术后腹膜转移（PM）的机制尚不清楚。本研究评估了在胃肠道 (GI) 重建之前残胃中是否存在包括癌症干细胞 (CSC) 在内的存活癌细胞，因为这些细胞可能是胃切除术后 PM 的来源。前瞻性地从 142 名接受远端胃切除术进行 GC 的连续患者中收集用于胃肠道重建前残胃腔冲洗的生理盐水并进行细胞学检查。对检测到的癌细胞的增殖活性（Ki67 染色）和干性（CSC 表面标志物 CD44s 或 CD44v6 的表达）进行评估。在 142 个残余胃中，有 33 个（23.2%）检测到活癌细胞。这些细胞形成簇并且 Ki67 染色呈阳性，表明增殖。这 33 例中有 10 例 (30.3%) 的残余胃癌细胞和原代 GC 中的表面癌细胞 CD44 或 CD44v6 染色也呈阳性。在多元逻辑回归分析中，晚期癌症（比值比 [OR]，4.65；95% 置信区间 [CI]，1.32-16.4；P = 0.017）、肿瘤大小为 40 mm 或更大（OR，3.78；95% CI，1.12-12.8；P = 0.033）和组织学分化（OR，3.10；P = 0.033）。 95% CI，1.30-7.40；P = 0.011）与残胃中癌细胞的存在独立相关。在胃肠道重建之前，在残胃管腔中发现了活的、增殖的和聚集的癌细胞，包括 CSC，这表明在 GC 治疗性胃切除术后可能存在 PM 的细胞来源。胃肠道重建期间应避免胃内容物播散至腹膜腔。
The mechanisms underlying peritoneal metastasis (PM) after curative gastrectomy for gastric cancer (GC) are not well elucidated. This study assessed whether viable cancer cells, including cancer stemlike cells (CSCs), were present in the remnant stomach immediately before gastrointestinal (GI) tract reconstruction because these could be a source of PM after gastrectomy.Saline fluid used for remnant stomach lumen irrigation before GI reconstruction was prospectively collected from 142 consecutive patients undergoing distal gastrectomy for GC and cytologically examined. Proliferative activity (Ki67 staining) and stemness (expression of the CSC surface markers CD44s or CD44v6) were evaluated in detected cancer cells.Viable cancer cells were detected in 33 (23.2 %) of the 142 remnant stomachs. These cells formed clusters and stained positively for Ki67, indicating proliferation. Cancer cells in remnant stomachs and surface cancer cells in primary GCs from 10 (30.3 %) of these 33 cases also stained positively for CD44s or CD44v6. In a multiple logistic regression analysis, advanced cancer (odds ratio [OR], 4.65; 95 % confidence interval [CI], 1.32-16.4; P = 0.017), tumor size of 40 mm or larger (OR, 3.78; 95 % CI, 1.12-12.8; P = 0.033), and histologic differentiation (OR, 3.10; 95 % CI, 1.30-7.40; P = 0.011) were associated independently with the presence of cancer cells in the remnant stomach.Viable, proliferative, and clustered cancer cells, including CSCs, were found in remnant gastric lumens immediately before GI reconstruction, indicating a possible cellular source of PM after curative gastrectomy for GC. Dissemination of gastric contents into the peritoneal cavity should be avoided during GI reconstruction.