Abstract
Background: Peritoneal lavage cytology in patients with gastric cancer may correlate with an unfavorable prognosis. This study evaluated the presence of free cancer cells in the peritoneal lavage of a population of patients with gastric cancer and its correlation with the outcome of surgical treatment.Methods: One hundred patients diagnosed with gastric or gastrointestinal junction adenocarcinoma underwent surgery. In all patients, a cytological and immunohistochemical analysis of peritoneal lavage was performed. Based on the presence of free cancer cells (fcc) at the cytological and immunohistochemical examination of peritoneal lavage, patients undergoing surgery for gastric cancer were divided into two groups: fcc (+) and fcc (–).Results: A total of 100 patients, 37 women, and 63 men with a median age of 65 years were included in the study. In the entire study group, 16 (16%) patients were positive for the presence of free cancer cells (fcc +) at peritoneal lavage examination. However, in the group of patients who underwent gastrectomy, fcc (+) was found in 10 out of 77 (13%) patients. The presence of cancer cells in peritoneal lavage was a strong predictive factor in an unfavorable outcome after surgery, and 1-year and 2-year patient survival was 34 and 0% in fcc (+) patients and 79 and 59% in fcc (–), respectively. Moreover, the presence of free cancer cells was associated with a five-fold increased risk of death within 2 years after surgery. When analyzing the group of patients undergoing R0/R1 surgery, this difference was even more significant (p < 0.0001).Conclusions: The presence of free cancer cells in peritoneal lavage may significantly affect the outcome of patients with gastric cancer. Radical surgery in patients with free cancer cells in the peritoneal lavage did not result in a survival advantage. Identification of free cancer cells could help for a better stratification of gastric cancer patients, identifying those patients who could better benefit from a radical surgical treatment, finally improving long-term survival.
Highlights
Many basic methods of peritoneal lavage analysis have been described in the literature: The classical cytology involving examination of a smear made from a cell pellet on the microscope slide and a pigment assessment conducted by an experienced pathologist [6], the immunohistochemical method using the reaction of antibodies against antigens present on cancer cells [7], the immunoenzymatic method assessing the CEA level in the supernatant after centrifugation of lavage fluid [8], and molecular methods involving the identification of cancer cell genes employing RT-PCR techniques [9]
When evaluating the survival of patients with free cancer cells in the peritoneal lavage undergoing surgery, this study demonstrated that there was no significant difference in survival among fcc (+) patients and patients unsuitable for surgical resection, irrespective of the presence of free cancer cells in the peritoneal lavage (p = 0.47)
This study reported an incidence of 13% positive peritoneal cytology among patients undergoing R0 resection for gastric cancer, similar to that reported in the literature, where a positive peritoneal lavage has been reported with an incidence ranging from 4.4 to 11% [20,21,22,23]
Summary
Many basic methods of peritoneal lavage analysis have been described in the literature: The classical cytology involving examination of a smear made from a cell pellet on the microscope slide and a pigment assessment conducted by an experienced pathologist [6], the immunohistochemical method using the reaction of antibodies against antigens present on cancer cells [7], the immunoenzymatic method assessing the CEA level in the supernatant after centrifugation of lavage fluid [8], and molecular methods involving the identification of cancer cell genes employing RT-PCR techniques [9]. This study evaluated the presence of free cancer cells in the peritoneal lavage of a population of patients with gastric cancer and its correlation with the outcome of surgical treatment
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