胃癌患者腹腔内游离癌细胞检测及其相关因素与预后

目的:探讨胃癌患者腹腔内游离癌细胞形成的相关因素。方法:对114例胃癌患者在手术中对肿瘤未行侵入性操作前予以腹腔冲洗液细胞学检测,分析腹腔游离癌细胞的产生与浆膜受侵、淋巴结转移、临床分期及病理分型等因素的相关性并对所有患者进行3年的追踪回访。结果:114例胃癌腹腔冲洗液细胞学阳性率为39·47%(45/114),淋巴结转移、临床病理分期、肿瘤病理类型与腹腔冲洗液细胞学阳性显著相关,P<0·01,腹腔游离癌细胞阳性者预示术后不佳。3年内,腹腔游离癌细胞阳性组45例患者无1例生存。结论:腹腔脱落癌细胞形成微转移性,是胃癌术后腹腔复发及转移的主要危险因素之一。肿瘤浸润深度,淋巴结转移及TNM分期与腹腔游离癌细胞呈正相关。术中检测游离癌细胞有助于评价病期、手术效果,并为辅助治疗提供依据。     

胃癌腹腔冲洗液游离癌细胞检测的临床意义

目的探讨检测胃癌患者的腹腔游离癌细胞的临床意义。方法检测163例行根治性切除的胃癌患者腹腔冲洗液中的游离癌细胞。结果当肿瘤浸透浆膜、有淋巴结转移时腹腔游离癌细胞检出率明显升高（P〈0．05）,而游离癌细胞检出率与有无脉管侵犯及神经侵犯无明显相关性（P〉0．05）。结论腹腔游离癌细胞与肿瘤侵犯深度及淋巴结转移情况密切相关。胃癌术后腹水游离癌细胞阳性患者,预后相对较差。     

胃癌术中腹腔冲洗液CK20mRNA、COX-2 mRNA检测及与腹膜微转移的相关性

目的:运用细胞学及实时荧光定量RT-PCR方法对胃癌术中腹腔冲洗液进行检测,以探讨对预测胃癌腹膜微转移的意义.方法:胃癌50例和胃良性病变10例,收集患者术中腹腔冲洗液,用实时荧光定量RT-PCR方法测定腹腔冲洗液中游离细胞的CK20mRNA、COX-2 mRNA表达,同时作冲洗液细胞学检测(PLC).结果:50例胃癌患者腹腔冲洗液中CK20mRNA阳性表达为62.0%(31/50);COX-2 mRNA阳性表达率60.0%(30/50),CK20mRNA、COX-2 mRNA联合检测阳性率为68.0%(34/50),皆高于腹腔冲洗液细胞学28.2%(11/50),CK20mRNA、COX-2 mRNA的阳性率与肿瘤分期、浸润深度、淋巴结转移、浆膜侵犯程度呈正相关.结论:CK20mRNA、COX-2 mRNA实时荧光定量RT-PCR方法检测腹腔微量游离癌细胞较PLC有更高的灵敏度,是一种检测胃癌腹膜微转移的有效方法.     

胃癌术中腹腔冲洗液CK20mRNA、COX-2 mRNA检测及与腹膜微转移的相关性

目的：运用细胞学及实时荧光定量RT-PCR方法对胃癌术中腹腔冲洗液进行检测,以探讨对预测胃癌腹膜微转移的意义。方法：胃癌50例和胃良性病变10例,收集患者术中腹腔冲洗液,用实时荧光定量RT-PCR方法测定腹腔冲洗液中游离细胞的CK20mRNA、COX-2 mRNA表达,同时作冲洗液细胞学检测（PLC）。结果：50例胃癌患者腹腔冲洗液中CK20mRNA阳性表达为62.0%（31/50）;COX-2 mRNA阳性表达率60.0%（30/50）,CK20mRNA、COX-2 mRNA联合检测阳性率为68.0%（34/50）,皆高于腹腔冲洗液细胞学28.2%（11/50）,CK20mRNA、COX-2 mRNA的阳性率与肿瘤分期、浸润深度、淋巴结转移、浆膜侵犯程度呈正相关。结论：CK20mRNA、COX-2 mRNA实时荧光定量RT-PCR方法检测腹腔微量游离癌细胞较PLC有更高的灵敏度,是一种检测胃癌腹膜微转移的有效方法。     

胃癌E-钙粘蛋白表达与腹腔游离癌细胞的相关性研究

目的探讨胃癌组织E-钙粘蛋白的表达与腹腔游离癌细胞的关系.方法应用细胞学和免疫组化方法(SABC法)分别检测64例胃癌病人腹腔游离癌细胞和胃癌组织E-CD的表达.结果E-CD在胃癌组织中表达下调,已侵透浆膜的胃癌组织E-CD为阴性表达、低表达及阳性表达时,其腹腔游离癌细胞检出率分别为52.63%,23.08%和10%,(P＜0.05).结论胃癌浸透浆膜后E-CD的无表达或表达下调是癌细胞脱落的一个重要原因.     

胃癌术中腹腔冲洗液Cox-2 mRNA及CEA mRNA检测临床意义的探讨

目的：探讨腹腔冲洗液Cox-2 mRNA及CEA mRNA检测的可行性和临床意义。方法：前瞻性比较胃癌腹腔冲洗液RT-PCR法与常规细胞学法（PLC）检出脱落癌细胞的阳性率。结果：32例胃癌患者腹腔冲洗液中Cox-2 mRNA及CEA mRNA检出阳性率分别为53．1％（17／32）及56．3％（18／32）,明显高于PLC检出癌细胞阳性率（21．9％）,Х^2分别为5．497及4．433,P〈0．05。17例RT—PCR法检出阳性病例中,COX-2 mRNA法检出16例（94．1％）,CEA mRNA法检出15例（88．2％）,两种基因腹腔冲洗液脱落癌细胞检测阳性率大致相同,且检测阳性率与浆膜浸润阳性、浆膜浸润面积大、病理组织学类型、淋巴结转移和TNM病期呈正相关。结论：RT—PCR法检测胃癌腹腔冲洗液Cox-2 mRNA与CEA mRNA表达,可显著提高脱落癌细胞的检测阳性率,具有广泛的临床应用价值和意义。     

y膜冲洗液中CEA水平预测胃癌根治术后的腹膜扩散

手术时无肿瘤残余迹象的胃癌患者,腹膜转移依然是最常见的复发类型,也是治愈胃癌的主要障碍。一般认为这是由于胃原发癌侵及浆膜表面,从而发生癌细胞微观扩散所致。手术时对腹膜冲洗液进行细胞学检查可发现脱落癌细胞。但至少50％死于腹膜复发的病人其细胞学检查阴性。很显然,细胞学检查依赖于取样方法和检测技术,因此对胃癌术后的预后意义不大。     

胃癌腹膜转移患者腹腔脱落细胞学阳性的影响因素分析

目的 探讨晚期胃癌腹膜转移患者中腹腔脱落细胞学阳性的相关影响因素.方法 纳入2017年6月至2020年6月在广东省中医院住院且病理明确为胃癌腹膜转移的患者60例,通过腹腔镜探查收集冲洗液并行腹腔冲洗细胞学检查(peritoneal lavage cytology,PLC).收集患者的性别、年龄、临床T分期、肿瘤部位、B...     

应用流式细胞术检测胃癌患者术中腹腔冲洗液脱落细胞的临床研究

  目的  应用流式细胞技术(flow cvtometry, FCM)对腹腔冲洗液进行DNA倍体分析, 作为胃癌腹腔脱落癌细胞(exfoliat-ed canceF cells, , ECC)检测的辅助手段为临床提供依据。  方法  收集62例胃癌患者术中腹腔冲洗液, 应用FCM进行脱落细胞DNA倍体分析, 同时行腹腔冲洗液细胞学(peritoneal lavage eytologv, PLC)检查, 比较二者的检测敏感度, 并分析FCM与胃癌不同临床病理特征的相关性。  结果  62例胃癌腹腔冲洗液流式细胞术DNA倍体分析检测阳性率为67.74%, 而PLC阳性率仅为33.87%, 两组差异有统计学意义(P < 0.001)肿瘤类型、浸润深度、受侵面积、淋巴结转移、脉管瘤栓、TNM分期与腹腔冲洗液异倍体肿瘤细胞相关(P均 > 0.05)在局限性胃癌、肿瘤浸润深度、浆膜受侵面积 < 10cm2、淋巴结转移、无脉管瘤栓、TNM分期方面腹腔冲洗液FCM检测阳性率优于PLC(P均 > 0.05)。  结论  流式细胞术可作为胃癌患者术中检测ECC的有效辅助诊断手段。      

肺癌术中胸腔冲洗液细胞学的临床意义

目的：研究术中胸腔冲洗液细胞学检测对肺癌患者的预后价值。方法：无恶性胸腔积液的100例肺癌患者，剖胸后及术毕胸膜腔冲洗，冲洗液行病理细胞学检查，术后患者随访。结果：冲洗液细胞学检测：术前阳性8例．术后阳性5例。3年生存率随访：冲洗液细胞学阳性者为20％，阴性者为60％。冲洗液阳性的相关因素包括：病理分期、细胞类型、肿瘤大小、胸膜侵犯程度。结论：术中胸膜腔冲洗液细胞学检查可提示胸膜腔的微转移，是一个重要的预后因素。     

Peritoneal cytology in the surgical evaluation of gastric carcinoma

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 (chi2 = 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.     

腹腔冲洗液中癌胚抗原、细胞角蛋白20水平预测胃癌患者腹膜微转移和判断预后的临床价值

目的 探讨检测胃癌患者腹腔冲洗液中癌胚抗原（CEA）、细胞角蛋白20（CK-20）水平对胃癌患者预测腹膜微转移和判断预后的价值.方法 收集行D2根治术并达到R0切除的105例胃腺癌患者临床及随访资料.收集患者腹腔冲洗液,常规行HE染色腹腔冲洗细胞学（PLC）检查,采用流式细胞术（FCM）检测患者腹腔冲洗液中CEA和CK-20的表达,以13例需行手术治疗胃良性病变患者作为阴性对照,以人类胃癌细胞株SGC-7901作为阳性对照.结果 105例胃癌患者腹腔冲洗液中CEA的阳性表达率为45.7％（48/105）;CK-20的阳性表达率为63.8％（67/105）;CEA和CK-20的联合检测阳性率为81.0％（85/105）,均高于PLC检查的29.5％（31/105）（P＜0.05）.CEA和CK-20阳性率与肿瘤是否侵犯浆膜、淋巴结转移、pTNM分期有关（P＜0.05）.CEA和CK-20均表达阴性的20例患者中位生存期为52.0个月,长于CEA和CK-20均表达阳性的30例患者（18.0个月）（P＜0.05）.结论 FCM检测,尤其是联合检测胃癌患者腹腔冲洗液中CEA、CK-20的表达可用于预测腹膜微转移,明显优于PLC检测.联合检测胃癌患者腹腔冲洗液CEA、CK-20的表达可有效预测胃癌患者预后.     

Impact of peritoneal cytology on survival of endometrial cancer patients treated with surgery and radiotherapy

Stage IIIA endometrial cancer includes patients with serosal or adnexal invasion and patients with positive peritoneal cytology only. In this study, we assessed the impact of peritoneal cytology on endometrial cancer survival. All endometrial cancer patients receiving surgery and radiotherapy at the Geneva University Hospitals between 1980 and 1993 were included. Stage IIIA cancers were categorised into 'cytological' stage IIIA (only positive peritoneal cytology) and 'histological' stage IIIA (serosal or adnexal infiltration). Survival rates were analysed by Kaplan-Meier method and compared using log-rank test. The prognostic importance of peritoneal cytology was analysed by multivariate regression analysis. This study included 170 endometrial cancers (112 stage I, 17 cytological stage IIIA, 18 histological stage IIIA, 9 stage IIIB+). Disease-specific survival of cytological stage IIIA was not different from stage I (94 vs 88% respectively, P=0.5) but better than histological stage IIIA (94 vs 51% respectively, P<0.01). Histological stage IIIA patients were at increased risk to die from cancer compared to stage I patients (HR 2.7, 95% CI 1.0-7.7), while cytological stage IIIA patients were not (HR 0.3, 95% CI 0.3-2.0). Cytological stage IIIA endometrial cancer has similar prognosis as stage l and better prognosis than histological stage IIIA. Additional research, definitively separating stage and cytology is warranted.     

Evaluation of positive cases with peritoneal lavage cytology in gastric cancer

Peritoneal dissemination with advanced gastric cancer is of significant problem. Peritoneal lavage cytology has been an effective method for the detection of early peritoneal dissemination since 1999. The accurate evaluation of peritoneal lavage cytology is unclear except for the same prognosis of peritoneal dissemination. We examined the clinical findings and the prognosis with positive cases in peritoneal lavage cytology. The prognosis of cases with P1CY1 or P2P3 group was poorer than in the P0CY1 or P0, CY1 group. We thus review the evaluation of peritoneal lavage cytology with gastric cancer in the Japanese and English literature. In addition, we describe the diagnosis of early peritoneal dissemination using peritoneal lavage tumor markers or molecular markers of peritoneal lavage.     

Prognostic significance of peritoneal lavage cytology in gastric cancer in Singapore

Background Peritoneal lavage cytology has been included as part of the staging process in the 13th edition of the Japanese Classification of Gastric Cancer. However, this procedure has neither been studied nor established in our population. We aimed to evaluate its prognostic relevance among our patients with gastric cancer. Methods A total of 142 consecutive patients with gastric carcinoma were recruited prospectively. All had histologically proven gastric carcinomas and had undergone laparotomy and intraoperative peritoneal lavage for cytological examination at Singapore General Hospital. The fluid recovered was centrifuged and stained by the Papanicolau method. All patients were followed up with endpoints of cancer recur-rence and mortality. Results There were 91 men and 51 women; 36 patients (25.4%) had positive peritoneal lavage. Patients with advanced macroscopic features, presence of vascular invasion, nodal involvement, advanced depth of tumor invasion and metastatic disease tended to have positive lavage, by univariate logistic regression analysis. Despite curative resections, patients with positive cytology had a more dismal disease-free survival (mean, 27 months vs 53 months; P < 0.0001 by log rank test) and higher recurrence rate (54.5% vs 19.3%; P = 0.007 by log rank test). There was also a trend towards earlier recurrences (median, 8 months vs 11 months; P = 0.37). By multivariate Cox regression stepwise analysis, advanced depth of tumor invasion and positive lavage cytology were found to be independent poor prognostic factors for disease-free survival. Conclusion Positive peritoneal lavage cytology correlated well with advanced features of gastric cancer. It is an independent poor prognostic factor and the procedure should be routinely performed. Integration of lavage status into our current staging systems may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer in our population.     

Positive peritoneal cytology in early-stage endometrial cancer does not influence prognosis

The aim of this study was to assess the prognostic importance of positive peritoneal cytology in early-stage endometrial cancer. All 278 stage I and 53 stage IIIA (without cervical involvement) endometrial cancer patients operated between 1980 and 1996, recorded at the Geneva Cancer registry, were included. Stage IIIA cancers were recategorised into 'cytological' stage IIIA (positive peritoneal cytology alone, n=33) and 'histological' stage IIIA (serosal or adnexal infiltration, n=20). Survival rates were analysed by Kaplan-Meier method and compared using log-rank test. The prognostic importance of cytology was analysed using a Cox model, accounting for other prognostic factors. The 5-year disease-specific survival of cytological stage IIIA cancer was similar to stage I (91 vs 92%) and better than histological stage IIIA cancer (50%, P<0.001). After adjustment for age, myometrial invasion, differentiation and radiotherapy, cytological stage IIIA patients were still at similar risk to die from endometrial cancer compared to stage I patients (hazard ratio (HR) 0.7, 95% confidence interval (CI): 0.18-2.3), while histological stage IIIA patients were at a four-fold increased risk to die from their disease (HR 4.2, 95% CI: 1.7-10.3). This population-based study shows that positive peritoneal cytology in itself has no impact on survival of patients with localised endometrial cancer. Based on the present and previous studies, FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) might consider reviewing its classification system.     

Curative resection of gastric cancer: Limitation of peritoneal lavage cytology in predicting the outcome

Patients with stage T3N0～2M0 gastric carcinoma (n = 108) were studied for relevant prognostic factors. Peritoneal lavage cytology (PLC) was performed in all. In univariate analysis, 5-year survival rates were better with smaller serosal invasion (diameter <3.0 cm vs. ≥3.0 cm, 61% vs. 37%, P < 0.05) and fewer metastatic nodes (≤5 vs. ≥6, 57% vs. 29%, P < 0.05). In multivariate analyses, only these two factors were significant. The predictive value of PLC was not shown in both univariate and multivariate analyses. Peritoneal recurrence occured in 14 (22%) of 77 patients with negative PLC, and in 3 (18%) of 17 with positive PLC, the difference being not significant. Our results indicate that PLC is insensitive in predicting the development of peritoneal recurrence. Its role in the estimation of survival is limited, as many will die of visceral or locoregional recurrence if not of peritoneal dissemination.