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.
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.
Authors: Y Ko; E Grünewald; G Totzke; M Klinz; S Fronhoffs; I Gouni-Berthold; A Sachinidis; H Vetter Journal: Oncology Date: 2000-06 Impact factor: 2.935
Authors: E Bando; Y Yonemura; Y Takeshita; K Taniguchi; T Yasui; Y Yoshimitsu; S Fushida; T Fujimura; G Nishimura; K Miwa Journal: Am J Surg Date: 1999-09 Impact factor: 2.565
Authors: Kimberly Moore Dalal; Yanghee Woo; Charles Galanis; Mithat Gonen; Laura Tang; Peter Allen; Ronald DeMatteo; Yuman Fong; Daniel G Coit Journal: J Gastrointest Surg Date: 2007-09-19 Impact factor: 3.452