An elevated preoperative serum calcium level is a significant predictor for positive peritoneal cytology in endometrial carcinoma

Objective:To evaluate preoperative serum calcium concentration and investigate the association between calcium level and positive peritoneal cytology in endometrial carcinoma(EC).Methods:A total of 510 patients who were diagnosed with EC and had surgery were initially enrolled in this study at Peking University People's Hospital between January 2012 and December 2016.Clinical characteristics and preoperative serum calcium,albumin,carbohydrate antigen(CA)125,CA19-9,carcinoembryonic antigen(CEA)were extracted from patient records and evaluated according to postoperative peritoneal cytology.Predictive factors were assessed with Cox univariate and multivariate analyses.Factors selected from multivariate analysis results were used to build a predictive model.Results:A total of 510 patients are identified in our database and 444 patients who fulfilled inclusion and exclusion criteria are included in this study.Univariate analysis revealed that ionized calcium concentration was closely related to positive peritoneal cytology,tumor grade and lymph-vascular space invasion(LVSI).Moreover,peritoneal cytology was significantly associated with hypertension,tubal ligation,serum CA125,CA19-9,CEA and ionized calcium level.Multivariate analysis revealed that albumin-adjusted calcium level,CA125 and tubal ligation were independent predictive factors of positive peritoneal cytology(P<0.05).A combination of ionized calcium level with the other two indexes yielded significantly great area under the curve(AUC=0.824).Conclusions:This study enhanced the value of preoperative ionized calcium level.We also identified several potential biomarkers to predict positive peritoneal cytology in EC patients before surgery.

Current treatment strategies for patients with only peritoneal cytology positive stage IV gastric cancer

Gastric cancer(GC)is one of the most common malignancies worldwide and surgery remains the only potentially curative treatment option for it.Although a significant proportion of GC patients are found with distant metastases already at the initial diagnosis.Peritoneal dissemination is the most common site of metastases.Positive peritoneal cytology(Cy1)is associated with poor long-term outcomes;thus,these patients are considered as stage IV even if macroscopic carcinomatosis is absent.Currently,there is no clear evidence for the most optimal treatment for this distinct subpopulation of the stage IV cohort.Available strategies vary from palliative chemotherapy to upfront gastrectomy.This comprehensive review summarized current evidence of different treatment strategies for Cy1 GC including roles of surgery,systemic and intraperitoneal chemotherapy.

Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation

AIM： To evaluate the efficacy of telomerase activity assay and peritoneal lavage cytology （PLC） examination in peritoneal lavage fluid for the prediction of peritoneal metastasis in gastric cancer patients, and to explore the relationship between telomerase activity and proliferating cell nuclear antigen expression.METHODS： Telomeric repeated amplification protocol （TRAP）-enzyme-linked immunosorbent assay （ELISA） was performed to measure the telomerase activity in 60 patients with gastric cancer and 50 with peptic ulcer. PLC analysis of the 60 patients with gastric cancer was used for comparison. The proliferating cell nuclear antigen （PCNA） in gastric carcinoma was immunohistochemically examined.RESULTS： The telomerase activity and PLC positive rate in peritoneal lavage fluid from patients with gastric cancer was 41.7% （25/60）, and 25.0% （15/60）, respectively. The positive rate of telomerase activity was significantly higher than that Qf PLC in the group of pT, （15/16 vs 9/16, P 〈 0.05）, P1-3 （13/13 vs 9/13, P 〈 0.05） and diffuse type （22/42 vs 13/42, P 〈 0.05）. The patients with positive telomerase activity, peritoneal metastasis, and serosal invasion had significantly higher levels of average PCNA proliferation index （PI）, （55.00 ± 6.59 vs 27.43 ± 7.72, 57.26 ±10.18 vs 29.15 ±8.31, and 49.82 ± 6.74 vs 24.65 ±7.33, respectively, P 〈 0.05）.CONCLUSION： The TRAP assay for telomerase activity is a useful adjunct for cytologic method in the diagnosis of peritoneal micrometastasis and well related to higher proliferating activity of gastric cancer. The results of this study also suggest a promising future therapeutic strategy for treating peritoneal dissemination based on telomerase inhibition.

Prognostic factors of T4 gastric cancer patients undergoing potentially curative resection

AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions.The clinicopathological factors that could be associated with overall survival were evaluated.The cumulative survival was determined by the Kaplan-Meier method,and univariate comparisons between the groups were performed using the log-rank test.Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. RESULTS:The study patients comprised 53 men (74.6%)and 18 women(25.4%)aged 39-89 years (mean,68.9 years).Nineteen patients(26.8%)had postoperative morbidity:pancreatic fistula developed in 6 patients(8.5%)and was the most frequent complication,followed by anastomosis stricture in 5 patients (7.0%).During the follow-up period,28 patients(39.4%)died because of gastric cancer recurrence,and 3(4.2%) died because of another disease or accident.For all patients,the estimated overall survival was 34.1%at 5 years.Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology(P<0.01),number of metastatic lymph nodes(P<0.05),and venous invasion(P <0.05).In multivariate analyses,only peritoneal washing cytology was identified as an independent prognostic factor(HR=3.62,95%CI=1.37-9.57)for longterm survival. CONCLUSION:Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.

Significance of peritoneal lavage cytology based on genetic signatures in gastric cancer

Perit on eal metastasis is the most comm on patter n of recurre nee and the most freque nt cause of death after surgery in patie nts with gastric can cer.Perit on eal free can cer cells dissem in ated from the primary lesi on site have bee n con sidered the main cause of perit on eal metastasis.Perit on eal lavage cytological exam in ati on(PLC)has bee n show n to be an in depe ndent predictor of gastric cancer relapse after curative resection and poor overall survival.However,the conventional cytological examinations have high rates of false-positive and false-negative findings.To improve the sensitivity,molecular-based methods using reverse transcriptase polymerase chain reaction have been developed for detecting cancer cells in peritoneal wash fluids of patients with gastric cancer.We performed a PubMed search for articles describing PLC in gastric can cer.Releva nt articles were reviewed and data on available outcomes elaborated.The cli nical roles and attributes of PLC in gastric can cer were reviewed,and its future applicati on to this disease is discussed.