胃癌患者腹腔游离癌细胞的检测及其临床意义

Clinical significance of intraperitoneal free cancer cells in gastric cancer patients

腹腔播散是进展期胃癌常见的转移方式,由于目前尚没有标准的检测胃癌腹腔微转移的方法,故大部分腹腔微转移的胃癌患者难以得到临床诊断。应用腹腔灌洗细胞学(PLC)检测腹腔游离癌细胞(IFCCs)的结果与腹腔镜检查结果相似,但是腹腔镜结合PLC可增加检查的敏感性。应用免疫组化和酶联免疫吸附试验可检测腹腔灌洗液(PLF)中IFCCs肿瘤标志,IFCCs预测胃癌复发的阳性预报值为91%,特异性为97%。应用免疫组化检测IFCCs是一个有效的、独立的预测胃癌生存期的阴性指标。应用酶联免疫吸附试验检测PLF中CEA水平是预测腹腔播散的指标,其诊断腹腔微转移的敏感性和特异性分别是75.8%和90.8%。应用PLF进行分子诊断的敏感性优于PLC、免疫组化和酶联免疫吸附试验。逆转录聚合酶链式反应(RTPCR)是一种新的诊断腹腔灌洗液中IFCCs的方法,基于靶基因的RTPCR方法可用于检测腹腔微转移的肿瘤分子标志。在IFCCs中表达的这些分子标志还可用于腹腔微转移治疗。存在IFCCs的胃癌患者的预后很差,无论应用哪种方法预测腹腔微转移都是困难的,但术前均应进行IFCCs检查,以明确诊断和指导治疗。

The peritoneal dissemination is the most common pattern of metastasis in advanced gastric carcinoma with serosal invasion. However, most patients with peritoneal micrometastases have heen excluded from clinical diagnoses because there is no standardized methoc for detection of peritoneal micrometastases. The results of peritoneal lay age cytology （PLC） in detecting intraperitoneal free cancer ceils （IFCCs） are similar with laparoscopy. Therefore, cytologic diagnosis of peritonea lavage adds sensitivity to laparoscopy during laparoscopic staging of patients with gastric carcinoma. The tumor markers in peritoneal lavage for peritoneal metastasis from gastric carcinoma are performed by using immunocytochemistry with the monoclonal antibody and chemiluminescen enzyme immunoassay, IFCCs have a positive predictive value of 91 % ant a specificity of 97% for gastric cancer recurrence. IFCCs are a strong negative, independent prognostic indicator for survival in gastric carcinoma by using immunocytochemistry. The CEA level is considered to be predictor of peritoneal dissemination by chemiluminescent enzyme immunoassay and its diagnostic sensitivity and specificity are 75.8% ant 90.8% respectively. Molecular diagnosis using peritoneal lavage fluic （PLF） is more sensitive than that using the PLC, immunocytochemistry and cbemiluminescent enzyme immunoassay. The reverse transcriptasepolymerase chain reaction （RT-PCR） is a new diagnostic method using or more target genes for detection of IFCCs in PLF. The high sensitivity of RT-PCR based target genes makes it tumor molecular marker for detecting peritoneal micrometastasis. These molecular marker expression in IFCCs also suggests a promising future therapeutic strategy for cases o gastric cancer involving peritoneal metastasis. Prediction of peritonea dissemination of gastric carcinoma is very difficult whatever method o examination is used and the prognosis of gastric carcinoma with IFCCs is poor. However, it is necessary to have a IFCCs examination before resection.