医学
危险系数
胃肠病学
胃切除术
癌症
内科学
预测标记
肿瘤标志物
比例危险模型
剖腹手术
肿瘤科
置信区间
病理
外科
作者
Katsushi Takebayashi,Satoshi Murata,Hiroyuki Kodama,Sachiko Kaida,Tsuyoshi Yamaguchi,Ken Ishikawa,Miyuki Shimoji,Toru Miyake,Tomoyuki Ueki,Masayasu Kojima,Hiroya Iida,Hiromitsu Maehira,Tomoharu Shimizu,Masaji Tani
出处
期刊:Ejso
[Elsevier]
日期:2022-01-01
卷期号:48 (1): 177-182
被引量:2
标识
DOI:10.1016/j.ejso.2021.05.012
摘要
Cancer cells in intraoperative peritoneal washings (PW) indicate increased peritoneal recurrence. Detection of CEA or CK20 genes indicates poor prognosis. We assessed long-term prognosis of patients with amplification of cancer-related genes in PW obtained intraoperatively during curative gastric cancer surgery.PW was collected before and immediately after curative gastrectomy. CEA, CK20, TFF1, MUC2, and FABP1-mRNA were selected as marker genes for reverse transcription polymerase chain reaction. Peritoneal recurrence-free survival (PRFS) and overall survival (OS) after >7-year follow-up were examined using the Kaplan-Meier method.Of 138 patients who underwent gastrectomy with negative cytological findings at laparotomy, 80 patients showed negative cancer-related gene amplification in preoperative PW. Fifty-eight patients were excluded due to positive gene amplification, which suggested presence of preoperative peritoneal cancer cells. The 80 patients had mRNA amplification in PW after surgery. Amplification of multiple and single cancer-related marker genes was observed in 38 and 21 patients; 21 cases had marker-negative results. Five-year PRFS was 69.1%, 95.2%, and 100% in multi-marker-positive, single marker-positive, and marker-negative cases, respectively. Multi-marker-positive patients had significantly worse PRFS than the other groups (p < 0.05). Multivariate analysis in the Cox proportional hazards model identified multi-marker-positivity as an independent prognostic factor for PRFS (hazard ratio, 7.6; 95% confidence interval, 1.07-62.63; p = 0.046), and multi-marker-positive patients had significantly worse OS than other groups (p < 0.01).Multi-marker cancer-related gene amplification in PW is associated with worse prognosis in PRFS and OS even after a long follow-up; PRFS can be stratified by the number of genes amplified.
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