Quantitative detection of disseminated free cancer cells in peritoneal washes with real-time reverse transcriptase-polym erase chain reaction - A sensitive predictor of outcome for patients with gastric carcinoma

被引:121
作者
Kodera, Y
Nakanishi, H
Ito, S
Yamamura, Y
Kanemitsu, Y
Shimizu, Y
Hirai, T
Yasui, K
Kato, T
Tatematsu, M
机构
[1] Aichi Canc Ctr Hosp, Dept Surg Gastroenterol, Chikusa Ku, Nagoya, Aichi 464, Japan
[2] Aichi Canc Ctr, Res Inst, Pathol Lab, Nagoya, Aichi 464, Japan
关键词
D O I
10.1097/00000658-200204000-00007
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective To evaluate the feasibility of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) detection of free cancer cells in the peritoneal washes as a prognostic indicator for patients with gastric carcinoma. Summary Background Data Peritoneal lavage cytology (CY) is an excellent prognostic determinant but lacks sensitivity. This can be improved by using RT-PCR to quantitate carcinoembryonic antigen (CEA) mRNA in peritoneal washes. Methods Peritoneal washes were obtained from 189 patients with gastric carcinoma during laparotomy, CEA mRNA levels and CEA/GAPDH mRNA ratios were quantified using a real-time PCR system with fluorescent hybridization probes. Receiver-operating characteristic plots were used to determine which of these parameters should be used as a marker for the intraperitoneal cancer cells. The prognostic significance of its positivity was then evaluated by Kaplan-Meier curves, and its value as an independent prognostic factor was evaluated by multivariate analysis. Results The sensitivity and specificity of real-time RT-PCR with an optimal cutoff value were 80% and 94%; those for conventional cytology were 56% and 91%. The survival of 16 patients who were CY-PCR+ was poor and approached that of 35 CY+ patients. Recurrence as peritoneal carcinomatosis was frequent among PCR+ patients but rare for their PCR- counterparts. PCR+ was a significant independent prognostic factor, along with the presence of node metastasis and serosal invasion, but CY+ was not. Conclusions Quantitative RT-PCR of peritoneal washes can replace cytologic examination as a tool for the sensitive evaluation of the risk of intraperitoneal recurrence in patients with gastric carcinoma.
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页码:499 / 506
页数:8
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