Detection of residual micro-cancer cells by the assessment of telomerase activities in postoperative pleural effusion after esophagectomy for esophageal cancer

为了确定细胞学检查和端粒酶活性评估是否有助于检测切除部位残留的微癌细胞，我们对食管癌切除术患者术后胸腔积液进行了这些检查。57例食管癌术后胸腔积液中有23例（40%）细胞学阳性（Papanicolaou IV类和V类）。23例细胞学阳性患者与34例细胞学阴性患者在原发肿瘤侵袭深度、血管侵袭阳性及淋巴结转移频率上无差异。前者11例（48%）复发，后者14例（41%）复发。11例细胞学检查呈阳性的患者局部肿瘤复发率为64%，14例细胞学检查呈阴性的患者局部肿瘤复发率为36%。然而，两组患者的局部复发率无显著差异。23例细胞学阳性患者4年生存率为60%。同样，34例细胞学阴性患者的生存率为60%。我们还研究了另外14例食管癌切除术患者术后胸腔积液中细胞学结果与端粒酶活性的相关性。14例患者均为细胞学阴性，胸膜积液端粒酶活性未检出。这些结果提示，部分食管癌患者食管切除术后癌细胞可在切除部位分散，微癌细胞残留并非食管癌食管切除术后局部肿瘤复发风险增加的可靠指标，端粒酶活性可能与食管癌患者食管切除术后胸腔积液中检测微癌细胞残留的细胞学检查相关。少

To determine whether cytologic examination and telomerase activity assessment are useful to detect residual micro-cancer cells in the resection sites, we performed these tests in the postoperative pleural effusion from patients with esophageal cancer undergoing esophagectomy. Positive cytology (Papanicolaou class IV and V) was detected in the postoperative pleural effusions from 23(40%) of 57 patients with esophageal cancer after esophageal resection. There no difference in depth of primary tumor invasion and frequencies of positive vessel invasion and lymph node metastasis between the 23 patients with positive cytology and 34 patients with negative cytology. Recurrent disease occurred in 11 (48%) of the former patients and 14 (41%)of the latter patients. Local tumor recurrence was found in 64% of the 11 patients with positive cytology and in 36% of the 14 patients with negative cytology. However, there was no significant difference in local recurrence rates between the two patient gro … More ups. The 4-year survival rates of the 23 patients with positive cytology were 60%. Likewise, those survival rates were 60% in the 34 patients with negative cytology. We also examined correlation between cytologic results and telomerase activities assessed by the TRAP method in the postoperative pleural effusions from other 14 patients with esophageal cancer undergoing esophagectomy. All of the 14 patients were revealed to have negative cytology and no detectable telomerase activities in the pleural effusion. These findings suggest that cancer cells can be scattered in the resection sites after esophagectomy in some patients with esophageal cancer, that residual micro-cancer cells are not reliable indicators of increased risk of local tumor recurrence after esophagectomy for esophageal cancer, and that telomerase activities may correlate with cytologic examination to detect residual micro-cancer cells in the postoperative pleural effusions after esophagectomy in patients with the disease. Less