Peritoneal cytology in the surgical evaluation of gastric carcinoma.
Peritoneal cytology in the surgical evaluation of gastric carcinoma.
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DOI：
10.1038/sj.bjc.6690081
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发表时间：
1999-02
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
--
作者：
许多接受手术治疗的胃癌患者会发生腹膜转移。一种识别有腹膜复发风险的患者的方法将有助于选择患者进行辅助治疗。腹膜细胞学在西方很少受到重视，但可能是评估胃癌患者的一种有用的附加手段。本研究的目的是评估胃癌患者腹膜细胞学取样技术，评估游离腹膜恶性细胞的预后意义，并发现手术过程对恶性细胞播散的影响。该研究基于85例连续接受手术治疗的胃癌患者，随访2年或直至死亡。在腹腔镜下和手术前通过腹腔灌洗和浆膜刷洗收集腹膜细胞学样本。切除后取标本进行腹膜灌洗，对切除标本进行印迹细胞学检查，术后经皮导管腹膜冲洗。恶性细胞由两名独立的显微镜诊断。术前腹腔灌洗85例中有16例（19%）出现恶性细胞。采用浆液涂刷法（4例）和印迹细胞学法（2例）提高了游离恶性细胞的产量；所有病例均有浆膜渗透的证据。一例血清阴性病例在切除后腹膜标本中表现出阳性细胞学，其中切除前细胞学标本为阴性。细胞学阳性组生存率较差（χ2 = 25.1; P < 0.0001）。在血清阳性的患者中，如果细胞学阳性，如果包括刷检和印迹细胞学产生的病例，生存率显着降低（log-rank检验= 8.44;1 df, P = 0.004）。综上所述，在预后不良的胃癌患者中可发现游离腹膜恶性细胞；除了常规的腹膜灌洗外，还可以通过刷刷和印迹细胞学来增加产量。通过这些方法评估腹膜细胞学可能在选择预后最差的患者中发挥作用，这些患者可能从辅助治疗中获益最多。©1999癌症研究运动
Many patients undergoing surgery for gastric carcinoma will develop peritoneal metastases. A method to identify those patients at risk of peritoneal recurrence would help in the selection of patients for adjuvant therapy. Peritoneal cytology has received little attention in the West, but may prove a useful additional means of evaluating patients with gastric cancer. The aims of this study were to evaluate sampling techniques for peritoneal cytology in patients with gastric cancer, to assess the prognostic significance of free peritoneal malignant cells and to discover the effect of the operative procedure on dissemination of malignant cells. The study is based on 85 consecutive patients undergoing surgical treatment of gastric cancer and followed up for 2 years or until death. Peritoneal cytology samples were collected at laparoscopy, and at operation prior to resection by intraperitoneal lavage and serosal brushings. After resection, samples were taken by peritoneal lavage, imprint cytology of the resected specimen and post-operatively by peritoneal irrigation via a percutaneous catheter. Malignant cells were diagnosed by two independent microscopists. Preoperative peritoneal lavage yielded malignant cells in 16 out of 85 cases (19%). The yield of free malignant cells was increased by using serosal brushings (by four cases) and imprint cytology (by two cases); all of the cases had evidence of serosal penetration. One serosa-negative case exhibited positive cytology in the post-resection peritoneal specimen in which the preresection cytology specimen was negative. Survival was worse in the cytology-positive group (χ2 = 25.1; P < 0.0001). Among serosa-positive patients, survival was significantly reduced if cytology was positive, if cases yielded by brushings and imprint cytology were included (log-rank test = 8.44; 1 df, P = 0.004). In conclusion, free peritoneal malignant cells can be identified in patients with gastric cancer who have a poor prognosis; the yield can be increased with brushings and imprint cytology in addition to conventional peritoneal lavage. Evaluation of peritoneal cytology by these methods may have a role in the selection of patients with the poorest prognosis who may benefit most from adjuvant therapy. © 1999 Cancer Research Campaign
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影响因子：
168.9
作者：
HAGIWARA, A;TAKAHASHI, T;SAKAKURA, C
通讯作者：
SAKAKURA, C
影响因子：
1.9
作者：
KENNEDY, BJ
通讯作者：
KENNEDY, BJ
影响因子：
105.7
作者：
SUELING, HM;JOHNSTON, D;AXON, ATR
通讯作者：
AXON, ATR
影响因子：
8.8
作者：
Allum WH;Hallissey MT;Ward LC;Hockey MS
通讯作者：
Hockey MS
影响因子：
7.3
作者：
SOOSAY, GN;GRIFFITHS, M;BOBROW, L
通讯作者：
BOBROW, L