Rt-PCR increases detection of submicroscopic peritoneal metastases in gastric cancer and has prognostic significance Journal Article
| Authors: | Wong, J.; Kelly, K. J.; Mittra, A.; Gonen, M.; Allen, P.; Fong, Y.; Coit, D. |
| Article Title: | Rt-PCR increases detection of submicroscopic peritoneal metastases in gastric cancer and has prognostic significance |
| Abstract: | Positive peritoneal cytology confers the same prognosis as clinical stage IV disease in gastric cancer. Conventional cytology examination, however, has low sensitivity. We hypothesize that real-time polymerase chain reaction (RT-PCR) may have increased sensitivity and provide more accurate staging information. From February 2007 to April 2009, peritoneal lavage samples were collected prospectively from 156 patients with biopsy-proven gastric cancer undergoing staging laparoscopy. These washings were analyzed by both Papanicolaou staining and RT-PCR for the tumor marker carcinoembryonic antigen (CEA). Visible peritoneal disease was seen at laparoscopy in 38 patients (LAP+, 24%). Cytology was positive (CYT+) in 23 patients, while RT-PCR was positive (PCR+) in 30. The sensitivity of CYT for the detection of visible disease was 61% compared to 79% for PCR (P = 0.02). No visible peritoneal disease was seen at laparoscopy (LAP-) in 118 (76%) patients. Eight (7%) were CYT+, while 28 (24%) were PCR+. Predictors of PCR positivity included advanced-stage disease (T3-4 vs. T1-2 tumors) and poor pathologic features such as vascular or perineural invasion. Long-term follow-up demonstrated a worse survival of LAP-CYT-PCR+ (P = 0.0003) and LAP-CYT+PCR+ (P = 0.0004) compared to LAP-CYT-PCR- patients. There was no significant difference in survival between CYT-PCR+ and CYT+PCR+ patients. PCR positivity also predicted a higher likelihood of disease recurrence after resection. An R0 resection was performed in 85 LAP- patients (54%): only 1 (1%) was CYT+, while 13 (15%) were PCR+. Of this group, PCR+ demonstrated a worse survival than PCR- patients (P = 0.02). Further analysis showed that, in R0 resection, stage III/IV, CYT- subgroup, PCR+ was associated with a trend towards worse survival (P = 0.09) compared to PCR- patients. RT-PCR for CEA increases the detection of subclinical peritoneal disease and is more sensitive than cytology. Predictors of positive PCR included advanced-stage disease, vascular invasion, and perineural invasion. PCR positivity was associated with increased disease recurrence and decreased survival. Further follow-up is required to determine if PCR positivity alone is an independent predictor of poor survival in gastric cancer. |
| Keywords: | immunohistochemistry; survival; adult; middle aged; survival analysis; mortality; comparative study; preoperative care; cancer staging; methodology; neoplasm staging; laparoscopy; prospective study; sensitivity and specificity; prospective studies; polymerase chain reaction; metastasis; cohort studies; peritoneal neoplasms; peritoneum lavage; cohort analysis; pathology; risk assessment; messenger rna; rna, messenger; biopsy, needle; needle biopsy; predictive value of tests; chi-square distribution; real time polymerase chain reaction; kaplan meier method; stomach neoplasms; peritoneum tumor; predictive value; stomach tumor; cytodiagnosis; peritoneal lavage; chi square distribution; kaplan-meier estimate; real-time polymerase chain reaction |
| Journal Title: | Journal of Gastrointestinal Surgery |
| Volume: | 16 |
| Issue: | 5 |
| ISSN: | 1091-255X |
| Publisher: | Springer |
| Date Published: | 2012-05-01 |
| Start Page: | 889 |
| End Page: | 896; discussion 896 |
| Language: | English |
| DOI: | 10.1007/s11605-012-1845-2 |
| PUBMED: | 22362071 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 9 January 2013" - "Source: Scopus" |
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