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.

Clinical value of expression of CEA and CK-20 in peritoneal washes on predicting peritoneal micrometastasis and prognosis of gastric carcinama

Objective To explore the clinical value of expression of CEA and CK-20 detected by flow cytometry （FCM） in peritoneal washes on predicting peritoneal metastasis and prognosis of gastric carcinama.Methods Clinicopathological characteristics and follow up data of 105 patients with gastric carcinoma who were underwent D2 radical resection （R0） were collected.Peritoneal washes was collected.Peritoneal lavage cytology examination （PLC） was used to find intraperitoneal free cancer cells （IFCC）.FCM was used to determine the CEA and CK-20 expressions.Meanwhile,13 patients with benign lesion on the stomach and the gastric carcinama cell line SGC-7901 were served as the negative and positive control,respectively.Results Positive expression of CEA was in 48 （45.7 ％） patients,of CK-20 was found in 67 （63.8 ％） patients,and of CEA and CK-20 was in 85 （81.0 ％） patients by FCM.However,positive expression of IFCCs was found in 31 patients（29.5 ％） by PLC.The expression of CEA and CK-20 were related to serosa invasion,lymphnode metastasis and pTNM stage （P ＜ 0.05）.The median survival of patients with negative expression of both CEA and CK-20 （n =20） was significantly longer those with positive expression （n =30）（52 vs 18 months,P ＜ 0.05）.Conclusions Combined Detection of CEA and CK-20 in peritoneal washes by FCM can be used to predict peritoneal micrometastasis and may predict the prognosis of gastric carcinoma.