Long-term prognosis of patients with cancer-related genes detected in postoperative peritoneal washings obtained during curative gastrectomy
Long-term prognosis of patients with cancer-related genes detected in postoperative peritoneal washings obtained during curative gastrectomy
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DOI：
10.1016/j.ejso.2021.05.012
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发表时间：
2022-01-31
期刊：
影响因子：
3.8
通讯作者：
Tani, Masaji
中科院分区：
文献类型：
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作者：
Takebayashi, Katsushi;Murata, Satoshi;Tani, Masaji
背景：术中腹腔冲洗液（PW）中的癌细胞表明腹膜复发增加。CEA或CK 20基因检测提示预后不良。我们评估了长期预后的患者与扩增的癌症相关基因在PW手术中获得根治性胃癌surgery.Methods：PW收集前和治疗性胃切除术后立即。选择CEA、CK 20、TFF 1、MUC 2和FABP 1-mRNA作为逆转录聚合酶链反应的标记基因。采用Kaplan-Meier法分析术后7年以上的腹膜无复发生存率（PRFS）和总生存率（OS）。结果：138例胃癌根治术后细胞学检查阴性的患者中，80例患者术前PW中癌相关基因扩增阴性。58例患者由于阳性基因扩增而被排除，这表明术前存在腹膜癌细胞。80例患者术后PW中有mRNA扩增。在38例和21例患者中观察到多个和单个癌症相关标记基因扩增; 21例标记阴性结果。多标志物阳性、单标志物阳性和标志物阴性病例的5年PRFS分别为69.1%、95.2%和100%。多标志物阳性患者的PRFS显著差于其他组（p < 0.05）。考克斯比例风险模型中的多变量分析将多标志物阳性确定为PRFS的独立预后因素（风险比，7.6; 95%置信区间，1.07-62.63; p = 0.046），多标志物阳性患者的OS显著低于其他组结论：PW中多标记癌相关基因扩增与PRFS和OS的预后相关，即使经过长期随访，PRFS也可以根据扩增基因的数量进行分层。(C)2021年爱思唯尔有限公司，BASO类似于癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Background: Cancer cells in intraoperative peritoneal washings (PW) indicate increased peritoneal recurrence. Detection of CEA or CK20 genes indicates poor prognosis. We assessed long-term prognosis of patients with amplification of cancer-related genes in PW obtained intraoperatively during curative gastric cancer surgery.Methods: PW was collected before and immediately after curative gastrectomy. CEA, CK20, TFF1, MUC2, and FABP1-mRNA were selected as marker genes for reverse transcription polymerase chain reaction. Peritoneal recurrence-free survival (PRFS) and overall survival (OS) after >7-year follow-up were examined using the Kaplan-Meier method.Results: Of 138 patients who underwent gastrectomy with negative cytological findings at laparotomy, 80 patients showed negative cancer-related gene amplification in preoperative PW. Fifty-eight patients were excluded due to positive gene amplification, which suggested presence of preoperative peritoneal cancer cells. The 80 patients had mRNA amplification in PW after surgery. Amplification of multiple and single cancer-related marker genes was observed in 38 and 21 patients; 21 cases had marker-negative results. Five-year PRFS was 69.1%, 95.2%, and 100% in multi-marker-positive, single marker-positive, and marker-negative cases, respectively. Multi-marker-positive patients had significantly worse PRFS than the other groups (p < 0.05). Multivariate analysis in the Cox proportional hazards model identified multi-marker-positivity as an independent prognostic factor for PRFS (hazard ratio, 7.6; 95% confidence interval, 1.07-62.63; p = 0.046), and multi-marker-positive patients had significantly worse OS than other groups (p < 0.01).Conclusion: Multi-marker cancer-related gene amplification in PW is associated with worse prognosis in PRFS and OS even after a long follow-up; PRFS can be stratified by the number of genes amplified. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.