胃癌患者术中腹腔游离癌细胞的检测及其与预后的关系

Detection of intraperitoneal free cancer cells in gastric cancer patients undergoing gastrectomy and its relationship with short-term prognosis

目的比较不同方法检测胃癌患者腹腔游离癌细胞（intraperitoneal free cancer cells,IFCCs）的阳性率．分析不同时点IFCCs的检测结果与胃癌患者短期预后的关系。方法连续纳入2014年7月至2016年3月期间于北京大学人民医院胃肠外科接受手术的119例胃癌患者，取开腹后即刻、手术操作完成后即刻、冲洗腹腔后3个时间点，分别以300～400ml生理盐水灌洗腹腔并收集灌洗液，进行传统离心法细胞学、滤膜法细胞学、免疫细胞化学以及RT—PCR方法检测IFCCs。采用Kaplan—Meier法绘制胃癌患者生存曲线。结果3个时点传统细胞学法检测IFCCs的阳性率分别为16．8％、20．7％、11．2％，免疫细胞化学法阳性率分别为28．6％、38．8％、20．7％，RT—PCR法阳性率分别为39．3％、69．5％、50．8％。RT—PCR法检测IFCCs的阳性率高于传统细胞学法和免疫细胞化学法（P〈0．05）。开腹后即刻时点．经任一方法检测1FCCs阳性患者的短期预后较阴性患者差（P〈0．05）。手术操作完成后即刻时点，仅传统细胞学法检测IFCCs阳性患者的短期预后较阴性患者差（P〈0．05）。结论IFCCs阳性胃癌患者的短期预后较阴性患者差；胃癌根治性手术切除前为检测IFCCs的最佳时机；手术操作可能增加IFCCs的脱落风险，手术操作完成后腹腔冲洗可减少IFCCs。

Objective To evaluate different methods in detecting intraperitontal free cancer cells （IFCCs） in patients with gastric cancer and to clarify the relationship between positive IFCCs and short-term prognosis. Methods A total of 119 gastric cancer patients who underwent surgical treatment were enrolled. Peritoneal lavage was performed with 300 -400 ml saline respectively at three points of time： immediately after abdominal cavity entry; when surgical operation was completed; when extensive intraoperative peritoneal lavage was done. The IFCCs were detected with methods of traditional centrifugal cytology, membrane cytology, ICC and RT-PCR. The survival curve of patients with gastric cancer was drawn using Kaplan-Meier method. Results The positive rate of PLC was 16. 8%, 20. 7% and 11.2% respectively at 3 timepoints （ P 〈 0. 05 ）. The positive rates of ICC were 28.6% , 38. 8% and 20. 7% respectively at 3 timepoints. The positive rates of RT-PCR were 39.3% , 69.5% and 50. 8% respectively at 3 time points. The positive rate of IFCCs detected through RT-PCR was higher than that of PLC and ICC （P 〈 0. 05）. The short-term prognosis of patients with positive IFCCs was worse than those with negative results detected with any three method at the timg point immediately after opening the abdomen （P 〈 0. 05 ）. At the timg point immediately after removing the tumors, the short-term prognosis of patients with positive IFCCs detected with PLC was worse （ P 〈 0. 05 ）. Conclusion The short-term prognosis was poor in patients with positive IFCCs. It is the best time to detect IFCCs before radical resection. Surgical procedures increase the risk of shedding of IFCCs.