Prognostic significance of CEA levels and positive cytology in peritoneal washings in patients with colorectal cancer

OBJECTIVE: The aims of this prospective study were to determine carcinoembryonic antigen (CEA) levels and incidence of cytology in peritoneal washings of patients with colorectal cancer, correlate the results with various histopathological factors and determine their significance as prognostic factors of the disease. METHODS: From 1992 to 1999, 98 patients with adenocarcinoma of the colon or intraperitoneal rectum underwent curative surgery and enrolled in this study. RESULTS: Overall, 25 (26.3%) of 95 patients were found to have positive cytology. The proportion of patients with positive cytology was higher in the recurrence group (36.4%) than in the groups of 5-year survival and hepatic metastases (24.6% and 26.3%, respectively), but this difference was not significant. The 5-year survival group had the lowest peritoneal CEA levels compared with the other groups, but this difference was not significant. Peritoneal cytology and CEA level alone were not sensitive, specific or accurate enough indicators in predicting survival, hepatic metastases or local recurrence. The analysis of patients with positive cytology and high peritoneal CEA level revealed that their combination can predict local recurrence with accuracy of 85%. CONCLUSIONS: The presence of free malignant cells, as detected by cytology and CEA level, in the peritoneal cavity of patients with resectable colorectal cancer had no detectable impact on survival, hepatic metastases or local recurrence rate. However, local recurrence can be predicted with accuracy of 85% in patients who have positive cytology and high peritoneal CEA level at the same time.     

The Value of Peritoneal Cytology as a Preoperative Predictor in Patients With Gastric Carcinoma Undergoing a Curative Resection

Background Although positive peritoneal cytology is associated with poor prognosis, it has not been found to be independently predictive of outcome when evaluated in context of post-resection pathologic T and N stage. This study was undertaken to evaluate the predictive value of positive cytology in context of other prognostic factors available prior to surgery in patients undergoing R0 resection for gastric cancer, to assess its role in selecting patients for appropriate treatment prior to surgical resection.Methods Clinical variables for all patients undergoing R0 resection for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1993–2002 were reviewed from a prospective database. Patients underwent preoperative assessment of T and N stage with CT scan, laparoscopy, and endoscopic and/or laparoscopic ultrasound. Peritoneal cytology was obtained in all patients.Results Patients with gastric cancer (n = 371) underwent R0 resection and staging laparoscopy with peritoneal washings; 24 patients (6.5%) had positive peritoneal cytology. Positive cytology was associated with advanced T stage (P = 0.02) but not with nodal positivity (P = 0.11). Median survival of patients with positive cytology was 14.8 months vs. 98.5 months for patients with negative cytology (P < 0.001). Multivariate analysis identified preoperative T stage, preoperative N stage, site, and cytology as significant predictors of outcome. Positive cytology was the preoperative factor most predictive of death from gastric cancer (RR 2.7, P < 0.001).Conclusions Positive cytology is information potentially available preoperatively that identifies a patient population at very high risk for early recurrence and death after curative resection of gastric cancer.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

Prognostic significance of carcinoembryonic antigen levels in peritoneal washes in patients with gastric cancer.

BACKGROUND: Peritoneal metastasis is the most frequent cause of death in patients with gastric cancer. Detection of free cancer cells in the peritoneal cavity at the time of surgery, therefore, is considered to be of great value in predicting the peritoneal recurrence and accordingly in the prognosis in patients with gastric cancer. This study examined the clinical significance of intraoperative determination of carcinoembryonic antigen (CEA) levels in peritoneal washes (pCEA) in patients with gastric cancer. METHODS: CEA levels in peritoneal washes were correlated retrospectively with several clinicopathologic factors including clinical outcome in 56 patients with resectable gastric cancer. RESULTS: Among several clinicopathologic factors, the depth of tumor invasion significantly and independently correlated with pCEA levels as revealed by multivariate stepwise logistic regression analysis. A significant difference in overall survival rates was observed between pCEA-positive and pCEA-negative groups: 5-year survival rates were 95.7% in pCEA-negative and 20% in pCEA-positive patients (P <0.0001). Multivariate analysis indicated that pCEA level is a statistically significant independent prognostic factor for the survival of patients with gastric cancer, and is an important factor for predicting peritoneal recurrence. CONCLUSIONS: pCEA could be a potential predictor of a poor prognosis as well as peritoneal recurrence in patients with gastric cancer. We believe that this information could contribute to determining the optimal intraoperative and postoperative therapeutic plan including adjuvant chemotherapy of gastric cancer.     

The Current Role of Staging Laparoscopy in Oesophagogastric Cancer

Introduction

Oesophagogastric cancers are known to spread rapidly to locoregional lymph nodes and by transcoelomic spread to the peritoneal cavity. Staging laparoscopy combined with peritoneal cytology can detect advanced disease that may not be apparent on other staging investigations. The aim of this study was to determine the current value of staging laparoscopy and peritoneal cytology in light of the ubiquitous use of computed tomography in all oesophagogastric cancers and the addition of positron emission tomography in oesophageal cancer.

Methods

All patients undergoing staging laparoscopy for distal oesophageal or gastric cancer between March 2007 and August 2013 were identified from a prospectively maintained database. Demographic details, preoperative staging, staging laparoscopy findings, cytology and histopathology results were analysed.

Results

A total of 317 patients were identified: 159 (50.1%) had gastric adenocarcinoma, 136 (43.0%) oesophageal adenocarcinoma and 22 (6.9%) oesophageal squamous carcinoma. Staging laparoscopy revealed macroscopic metastases in 36 patients (22.6%) with gastric adenocarcinoma and 16 patients (11.8%) with oesophageal adenocarcinoma. Positive peritoneal cytology in the absence of macroscopic peritoneal metastases was identified in a further five patients with gastric adenocarcinoma and six patients with oesophageal adenocarcinoma. There was no significant difference in survival between patients with macroscopic peritoneal disease and those with positive peritoneal cytology (p=0.219).

Conclusions

Staging laparoscopy and peritoneal cytology should be performed routinely in the staging of distal oesophageal and gastric cancers where other investigations indicate resectability. Currently, in our opinion, patients with positive peritoneal cytology should not be treated with curative intent.     

Carcinoembryonic antigen to detect hepatic metastases of colorectal cancers

Purpose. The spread of colorectal carcinoma (CRC) affects both staging and treatment. In this prospective study we examined the relationship between carcinoembryonic antigen (CEA) levels in bile, mesenteric venous blood, and peripheral venous blood, and the presence of occult hepatic metastases in patients with CRC.Methods. Sixty patients who underwent elective surgery at Ankara Oncology Hospital were voluntarily assigned to one of the three groups of 20 patients each. The control group consisted of patients operated on for benign biliary disorders, the second group consisted of patients with CRC without metastases, and the third group consisted of patients with CRC and isolated liver metastases. Bile, mesenteric venous blood, and peripheral venous blood was collected perioperatively for the measurement of CEA levels.Results. The bile CEA levels were significantly higher in the CRC patients with metastases than in those without metastases and the controls. The CEA levels in the mesenteric venous blood and peripheral venous blood were significantly higher in the two groups of CRC patients than in the control group. Overt hepatic metastases later developed in seven patients from the CRC without metastases group who had relatively high CEA levels, but the difference was not significant.Conclusion. The CEA levels in bile, mesenteric venous blood, and peripheral venous blood were increased in patients with CRC and liver metastases. The detection of elevated CEA levels in bile taken at surgery did not herald metachronous hepatic metastases in CRC patients without liver metastases.     

Peritoneal Cytology Does Not Increase the Prognostic Information Provided by TNM in Gastric Cancer

Background This study aimed at verifying whether peritoneal cytology could improve the prognostic information provided by TNM staging in gastric cancer patients. Method The presence of free peritoneal tumor cells was investigated in 168 patients who underwent curative resection for gastric cancer from January 1992 to July 2002 in Verona, Italy. The influence of peritoneal cytology on survival was evaluated by a Cox regression model, controlling for potential confounders. Results Twenty-three patients (14%) had positive peritoneal cytology. Patients with positive lavage were more likely to present serosal infiltration (100 vs. 46%) and nodal metastases (91 vs. 67%; P < 0.001). Positive lavage was associated with a very poor prognosis: 3-year survival was only 9% (95% CI 2–27%) when peritoneal cancer cells had been detected, whereas survival reached 50% (95% CI 42–59%) in patients with a negative cytology. In multivariate survival analysis, peritoneal cytology was an independent predictor of mortality when controlling for sex, age, site, histology, and nodal metastases, but not when adjusting also for depth of tumor invasion (RR of positive versus negative = 1.2, 95% CI 0.7–2.0). Similarly, the influence of peritoneal cytology on survival was no longer significant when univariate analysis was restricted to T3/T4 patients (RR = 1.5, 0.9–2.5). Conclusions Positive peritoneal cytology was a marker of poor prognosis in gastric cancer patients. Nevertheless, peritoneal lavage did not increase the prognostic information already provided by the TNM staging system in this Italian series.     

Monitoring carcinoembryonic antigen in colorectal cancer: Is it still useful?

The results of a study conducted to determine the usefulness of carcinoembryonic antigen (CEA) monitoring in the follow-up of patients with resected colorectal cancer are reported herein. The subjects of this study were 125 patients in whom CEA had been determined preoperatively and 239 patients in whom CEA had been monitored postoperatively. The results revealed increased preoperative CEA in only 24% of the subjects, and that this increment was correlated with subsequent more advanced tumor stage and a higher recurrence rate (P<0.01). The postoperative CEA level exceeded the threshold in 71% of the patients affected by recurrence, 94.4% of whom developed liver metastases and 50%, nonhepatic recurrence. This marker showed elevated sensitivity for liver metastases (99%), whereas the sensitivity was lower for nonhepatic recurrence of the disease (94%). Thus, we concluded that CEA monitoring can be useful for preoperative colorectal tumor grading, even if its validity in the early diagnosis of recurrence is problematic, especially in terms of radical repeated surgery and survival.     

CEA RT-PCR检测胃癌腹腔灌洗液游离癌细胞临床价值的初步观察

目的：初步观察癌胚抗原(CEA)逆转录．聚合酶链反应(RT-PCR)检测胃癌腹腔洗液中游离癌细胞的临床价值。方法：收集36例进展期胃癌和6例慢性胆囊结石病人腹腔灌洗液100ml，其中50ml行CEA RT-PCR，扩增CEA特异性片断；50ml行细胞学检查。胃癌细胞株MKN-45为阳性对照。结果：36例胃癌病人腹腔灌洗液中14例于131 bp处见CEA的特异性条带，阳性率为38．9％(14／36)；6例慢性胆囊结石病人腹腔灌洗液RT-PCR结果均为阴性；MKN-45在131bp处发现CEA的特异性条带。细胞病理学检查，36例胃癌病人中有6例腹腔灌洗液中发现有肿瘤细胞或核异形细胞，阳性率为16．6％(6／36)，且此6例RT-PCR结果均为阳性；8例RT-PCR结果阳性病人的细胞学检查为阴性。CEA RT-PCR的阳性率与肿瘤胃壁浸润深度、淋巴结转移数和胃癌分化程度明显相关。随访至今，36例进展期胃癌病人中CEA RT-PCR检查阴性的病人尚无一例腹腔内肿瘤复发，1例细胞学检查阴性而CEA RT-PCR阳性的病人术后4个月时出现腹腔内肿瘤复发。结论：腹腔灌洗液中胃癌细胞CEA mRNA的RT-PCR检测法敏感性较高．初步临床观察及随访显示该法有望作为诊断腹腔内游离癌细胞的有效辅助手段。     

Results of an Aggressive Approach to Resection of Locally Recurrent Rectal Cancer

Background The value of resection for locally recurrent rectal cancer (LRRC) remains controversial. We analyzed outcomes of an aggressive approach to resection of LRRC. Methods We conducted a retrospective chart review of 52 consecutive patients who underwent resection of LRRC from September 1997 through August 2005. Overall and disease-free survival (OS, DFS) curves were constructed by the Kaplan–Meier method, and compared by log-rank analysis. Median follow-up time was 29 months (range 3–72). Results Thirty-one patients (60%) were male. Median age was 60 years (range 36–88). Forty-six of the 52 patients were resected with curative intent, while 6 had known distant metastases at the time of resection. All 52 patients underwent grossly complete resection of local disease, and 41 (79%) had microscopically clear resection margins. An en bloc sacrectomy was performed in 28 (54%) patients. Postoperative mortality was nil; significant complications developed in 42% of patients. The complication rate was higher in patients with sacrectomy than without (50 vs. 33%, P = 0.017, Chi square). For the entire cohort of 52 patients, median OS and DFS were 40 and 24 months, respectively. Survival was equivalent in patients with and without sacrectomy. In the 46 patients who had resection with curative intent, 4-year OS was 48%. Median OS in the six patients with distant metastases at the time of resection was 21 months. OS was predicted by the presence of metastases (P = 0.01), and margin status (P < 0.0001). DFS was predicted by margin status (P = 0.0001). Conclusions In this series of patients who underwent resection of LRRC, microscopic margin status was the most significant predictor of OS and DFS. Requirement for en bloc sacrectomy was not associated with inferior survival. Carefully selected patients with distant metastases may benefit from resection of LRRC.     

腹腔镜胃癌根治术后腹腔游离癌细胞的变化及意义

目的 对比研究腹腔镜与开腹胃癌根治术后腹腔游离癌细胞的变化,探讨腹腔镜胃癌根治术的安全性及可行性.方法 收集2006年4月至2008年6月间63例腹腔镜、61例开腹胃癌根治术患者术前、术后腹腔灌洗液,分别运用细胞学和荧光定量PCR方法 检测腹腔游离癌细胞的阳性率和癌胚抗原(CEA)mRNA的表达变化,观察胃浆膜受侵面积与腹腔游离癌细胞阳性率的关系.结果 腹腔镜组术后腹腔灌洗液游离癌细胞的阳性率为25.4%,与开腹组(29.5%)比较差异无统计学意义(P＞0.05);腹腔镜组术后腹腔灌洗液CEA mRNA阳性率为41.3%,与开腹组(40.3%)比较差异亦无统计学意义(P＞0.05).腹腔镜组术前、术后腹腔游离癌细胞均为阳性的病例,其浆膜平均受侵面积为(16.2±2.2)cm2,而术前、术后游离癌细胞均为阴性的病例,其浆膜平均受侵面积为(5.3±0.8)cm2,腹腔游离癌细胞的阳性率与浆膜受侵面积呈正相关(R2=0.874,P=0.000).结论 腹腔镜胃癌根治术并不增加腹腔游离癌细胞的阳性检出率.     

Value of Carcinoembryonic Antigen Assay in Predicting Hepatic Metastases, Local Recurrence, and Survival After Curative Resection of Colorectal Cancer

Purpose We measured carcinoembryonic antigen (CEA) levels in peripheral and portal venous blood, and bile from patients with colorectal cancer, to determine its role in predicting hepatic metastases, local recurrence, and survival. Methods The subjects were 73 patients who underwent curative surgery for colorectal cancer. Results The median serum, bile, and portal CEA levels were significantly lower in 5-year survivors than in patients in whom hepatic metastases or recurrent disease subsequently developed. The CEA level in portal blood and bile was a good indicator of hepatic metastases, with sensitivity of 92% and 100%, respectively. However, the accuracy of any CEA measurement for predicting hepatic metastases, local recurrence, or 5-year survival did not exceed 70%. Conclusions None of these CEA measurements is accurate enough to be the basis of a management decision. Thus, we suggest that CEA measurement be used to assist in the prediction of a high risk of the development of hepatic secondaries and that these patients are followed up closely after curative resection.     

Peritoneal cytology in colorectal cancer: incidence and prognostic value

BACKGROUND: The value of peritoneal washing cytology on prognosis is not clear yet. The aims of our prospective study were to consider the incidence and prognostic value of peritoneal cytology. METHODS: From 1996 to 2003, washing cytology was performed in 88 patients who underwent surgery for colorectal cancer. Before exploration and manipulation of the tumor, each of the peritoneal cavities next to the tumor site, subhepatic and rectovesical recesses, were irrigated with 50 mL saline, and then the aspirates were taken for cytological evaluation. RESULTS: Thirteen (14.7%) of 88 patients had positive cytology. Although necrosis, depth of invasion, differentiation of the tumor, macroscopic peritoneal dissemination, and ascites were correlated with positive cytology; multivariate analyses revealed the depth of invasion, presence of necrosis, and differentiation of the tumor as the factors affecting the cytology. The disease-free and overall-survival times in patients with positive and negative peritoneal washing cytology were 56.36, 61.40 and 52.08, 63.94 months, respectively (P > .05). CONCLUSION: The presence of free malignant cells in the peritoneal cavities of patients who underwent curative resection for colorectal cancer provides no further prognostic value over the current staging systems.     

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目的　研究细胞角蛋白 2 0 (CK2 0 )和癌胚抗原 (CEA)单抗免疫细胞化学 (ICC)染色方法在胃癌病人腹腔冲洗液脱落癌细胞检测中的临床应用价值。方法　应用CK2 0和CEA两种标志物 ,对 30例胃癌病人腹腔冲洗液细胞涂片进行免疫细胞化学染色及常规腹腔冲洗液细胞学检查 (CY) ,检测腹腔内脱落癌细胞。结果　ICC阳性检出率 (43 3%)明显高于CY (2 3 3%) (P <0 0 5 ) ;CK2 0单抗检出 13例ICC阳性病例中的 12例(92 3%) ,优于CEA(76 9%) ;腹腔内癌细胞的脱落与浆膜受侵、胃癌分化程度、有无淋巴结转移相关 (P <0 0 5 ) ,并与临床分期密切相关 (P <0 0 1)。结论　采用CK2 0单抗免疫细胞化学染色方法检测腹腔冲洗液中脱落癌细胞是一种简单有效的方法 ,有临床实用价值。     

腹腔液胃癌细胞学与CEA mRNA检测比较的意义

目的：探讨胃癌病人术中腹腔冲洗液细胞学及腹腔冲洗液、腹膜组织中的癌胚抗原（CEA）mRNA，以探讨对腹腔中游离癌细胞和预测腹膜转移的诊断价值。方法：收集48例胃癌和5例胃良性病变病人的腹腔冲洗液或腹水，并同时切除少量大网膜、膈腹膜和盆腔腹膜作为对照。冲洗液行常规细胞学检查，并逆转录－聚合酶链反应（RT－PCR）法检测腹腔游离癌细胞和网膜组织中CEA mRNA的表达。结果：腹腔冲洗液和腹膜组织中的CEA mRNA的阳性率分别为39．58％（19／48）和43．75％（21／48），皆高于腹腔冲洗液细胞学27．08％（13／48）（P＜0．05）。CEA mRNA的表达与淋巴结转移、肿瘤浸润深度、浆膜侵犯程度及TNM分期呈正相关。结论：腹腔冲洗液CEA mRNA和细胞学检查是检测腹腔游离癌细胞和预测腹膜转移的有效方法；如同时行腹膜组织CEA mRNA的检测可能更有助于诊断。     

The clinical usefulness of preoperative CEA determination in gastric cancer

Between 1980 and 1984, preoperative serum carcinoembryonic antigen (CEA) was determined in 468 patients with gastric cancer to evaluate its clinical usefulness. The positive rate of preoperative CEA was 20.9 per cent in these 468 patients. A significantly higher CEA positive rate was obtained in those patients with liver metastasis (69.2 per cent), n_3–4 (40.0 per cent), stage IV gastric cancer (37.0 per cent) and Pap, Tub₁ histological type (26.3 per cent) (p<0.01). It is interesting that the positive rate of the 49 unresectable patients was 51.0 per cent, which was significantly higher than 17.4 per cent of the 419 resectable cases (p<0.01). CEA levels in 16 of the 39 patients with liver metastasis were more than 100 ng/ml. In contrast, serosal invasion and peritoneal metastasis were less correlated to the CEA positive rate. In the 419 resected cases, the 5 year survival rate in the higher CEA group of more than 50 ng/ml (35 cases) was 4.4 per cent, which was significantly lower than 64.0 per cent in the negative group (346 cases) (p<0.01). These results show that CEA determination in patients with gastric cancer is useful for the prediction of prognosis, as well as for a diagnostic tool to discover the presence of liver or lymph node metastasis.     

PATTERNS OF SERUM CEA FALL AFTER HEPATIC ARTERIAL CHEMOTHERAPY AS SOLE THERAPY AND COMBINED WITH CRYOTHERAPY FOR COLORECTAL METASTASES

Background : Hepatic artery chemotherapy (HAC) and cryoablation are treatments for unresectable liver metastases from colorectal carcinomas. Our centre has previously published data that describe survival statistics of patients after each of these treatments. It has also been established that serial serum carcinoembryonic antigen (CEA) concentrations may be used to monitor disease progress, and that the magnitude of fall is prognostic for both treatments. The pattern of fall of CEA following cryotherapy and regional chemotherapy has not previously been compared. Methods : In this study, we examined 26 HAC patients and 24 cryotherapy patients. Results : The mean percentage of the pre-treatment CEA concentration for the HAC group was 60.5% at 50 days and 29.4% at 150 days, and for the cryotherapy group 24.9% at 50 days and 24.3% at 150 days. Calculating the difference between means revealed a significantly different mean fall in the cryotherapy group at 50 days (P < 0.001) and a difference in mean fall at 150 days (P > 0.1) which was not significant. In patients who responded to hepatic artery chemotherapy, the eventual CEA fall was very similar in magnitude. Conclusions: The pattern of fall of CEA differs in these two treatments.     

Association of Tyrosine <Emphasis Type="Italic">PRL-3</Emphasis> Phosphatase Protein Expression with Peritoneal Metastasis of Gastric Carcinoma and Prognosis

Purpose In gastric carcinoma, high expression of PRL-3, a protein tyrosine phosphatase, is associated with lymph node metastasis. We studied the relationship between PRL-3 expression and peritoneal metastasis in gastric carcinoma. Methods Immunohistochemical analysis using the anti-PRL-3 antibody was done in 639 patients with gastric carcinoma including 89 with peritoneal metastases. We then compared the clinicopathologic characteristics of the PRL-3-positive and PRL-3-negative carcinomas. Results PRL-3 was expressed in 70.4% of the primary gastric carcinomas overall; in 80.9% of the cancers with peritoneal metastasis and in 68.7% of those without peritoneal metastasis (P = 0.020). PRL-3 expression was higher in peritoneal metastasis than in the corresponding primary gastric cancers (P = 0.028). PRL-3 expression was correlated with tumor stage (coefficient = 0.343, P = 0.01) and cancer progression, including lymphatic invasion (coefficient = 0.325, P = 0.02), extent of lymph node metastasis (coefficient = 0.322, P = 0.01), and peritoneal metastasis (coefficient = 0.316, P = 0.03). Patients who were PRL-3-negative had a better survival rate than those who were PRL-3-positive at all stages (stage I: log-rank P = 0.046, Wilcoxon P = 0.048; stage II: log-rank P = 0.035, Wilcoxon P = 0.041; stage III: log-rank P = 0.027, Wilcoxon P = 0.033; stage IV: log-rank P = 0.032, Wilcoxon P = 0.030). Conclusions Peritoneal metastasis appears to be correlated with PRL-3 expression, tumor stage, lymphatic invasion, and extent of lymph node metastasis. PRL-3 expression was negatively correlated with prognosis in patients with gastric cancer.     

VEGF Expression Predicts Survival in Patients with Peritoneal Surface Metastases from Mucinous Adenocarcinoma of the Appendix and Colon

Background High levels of vascular endothelial growth factor (VEGF) in ovarian cancer metastases are associated with a worse prognosis in patients treated with chemotherapy. VEGF-directed therapy improves survival for those with metastatic colorectal cancer. Patients with mucinous adenocarcinomas metastatic to the peritoneal surfaces can be treated with cytoreductive surgery, and both tumor grade and cytoreduction status are prognostic. We hypothesized that angiogenic indices may be prognostic in patients undergoing cytoreductive surgery for mucinous adenocarcinoma of the appendix and colon. Methods Cytoreductive cases from a 5-year period from the University of Cincinnati peritoneal malignancy database were reviewed. CD 34 counts (blood vessels) and VEGF expression was evaluated by means of immunohistochemistry on specimens from patients undergoing cytoreductive surgery and intraperitoneal hyperthermic perfusion (IPHP) for mucinous adenocarcinoma. Results A total of 26 males and 9 females, with a mean age of 50 years, underwent cytoreductive surgery and IPHP for mucinous adenocarcinoma of appendiceal (n = 32) or colonic (n = 3) origin. With a mean follow-up of 18 months (range 1–63 months), 23 had disease recurrence and 12 were alive without recurrence. The mean survival was 19 months (range 1–63 months). CD34 counts did not correlate with recurrence or survival; however, average VEGF counts correlated with survival (P = 0.017), and, for patients with recurrence, this correlation was stronger (P = 0.002). Conclusions These results suggest that markers of tumor angiogenesis may predict survival in patients with peritoneal surface metastases from mucinous adenocarcinoma. These findings provoke the hypothesis that antiangiogenic therapies may be effective in patients with this devastating disease. Presented at the 59^th Annual Cancer Symposium, The Society of Surgical Oncology, San Diego, CA, 23-26 March, 2006     

腹腔冲洗液检测CEA预测胃癌腹膜种植转移的临床意义

目的 探讨检测胃癌腹膜转移诊断的方法.方法 收集50例胃癌患者(胃癌组)及10例胃良性病变患者的腹腔冲洗液,并以胃癌原发灶组织标本作为对照.采用流式细胞术检测标本中肿瘤标志物CEA,采用HE染色进行腹腔冲洗液细胞学(PLC)检查,同时分析上述资料的临床意义.结果 胃癌组腹腔冲洗液中CEA阳性表达率为54.0%(27例),明显高于PLC所检测的24.0%(12例)的阳性率(P＜0.05).阳性检出率随着肿瘤浸润深度,TNM分期,胃壁受侵程度的增加而增加.胃癌组原发灶中CEA的阳性表达率为86.0%(43例),对照组腹腔冲洗液中CEA无阳性表达.结论 流式细胞术检测腹腔冲洗液中CEA可作为预测胃癌腹膜种植转移的手段.     

胃癌患者腹腔冲洗液中脱落癌细胞免疫细胞化学检测的价值

目的探讨一组正反互补单克隆抗体对胃癌患者腹腔冲洗液中脱落癌细胞检测的应用价值。方法应用低分子量细胞角蛋白(CKLMW)、癌胚抗原(CEA)、间皮细胞(MC)及波形蛋白(Vim)4种标志物,对67例胃癌患者腹腔冲洗液中的癌细胞成分进行免疫细胞化学(ICC)检测,并与常规细胞病理学(CP)检测结果比较。结果ICC阳性检出率(86.2%)明显优于CP阳性诊断率(58.6%)(P<0.05);ICC阳性检出率随侵袭深度及病期进展而增加;CKLMW、CEA、MC及Vim4种抗体的可用度分别为64.6%、71.6%、77.9%、41.8%。结论联合应用CKLMW、CEA及MC对于检测胃癌腹腔冲洗液中脱落癌细胞具有重要的临床价值,而Vim缺乏诊断意义。