腹腔冲洗液和腹膜组织检测胃癌腹腔微转移的临床意义

Clinical significance of free cancer cells in peritoneal washes and tissues of patients with gastric cancer

目的:运用细胞学及RT-PCR方法对胃癌患者术中腹腔冲洗液、腹膜组织进行检测,以探讨对预测胃癌腹腔微转移的意义.方法:胃癌68例和胃良性病变5例,收集患者术中腹腔冲洗液,并同时切除少量大网膜、腹膜作为对照.用RT-PCR方法测定冲洗液中游离细胞的CEAmRNA表达,同时作冲洗液细胞学检查(PLC).结果:腹腔冲洗液和腹膜组织中的CEAmRNA的阳性率分别为36.8%(25/68),和38.2%(26/68),皆高于腹腔冲洗液细胞学25.0%(17/68).CEAmRNA的阳性率与肿瘤的分化程度、浸润深度、淋巴结转移、浆膜侵犯深度呈正相关.结论:CEART-PCR方法对于检测腹腔微量游离癌细胞较PLC有更高的灵敏度和特异性,是一种检测胃癌腹腔微转移的有效方法.

AIM： To detect the free cancer cells in the peritoneal washes and tissues, and to explore their significances in the prediction of peritoneal metastasis of gastric cancer. METHODS： The peritoneal washes and tissues were collected during laparotomy from 38 patients with gastric cancer and 5 with benign gastric disease. Peritoneal lavage cytology was performed for the washes, and the carcinoembryonic antigen （CEA） mRNA of the free cancer cells was detected by reverse transcription polymerase chain reaction （RT-PCR）. RESULTS： The CEA mRNA positive rates of the free cancer cells in the peritoneal washes and tissues were 36.8% （25168） and 38.2% （26/68）, respectively, which were both higher than that of cytological examination [25.0% （17/68）]. The TNM staging, depth of invasion,lymph node metastasis, serosal involvement were correlated with the positive rate of CEA mRNA. CONCLUSION： CEA mRNA is more sensitive and specific in the detection of peritoneal micrometastasis of gastric cancer.