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Utility of Molecular Analysis of Peritoneal Fluid in Staging Laparoscopy of Advanced Esophagogastric Junction and Gastric Cancer Prior to Neoadjuvant Treatment

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Abstract

Purpose

Molecular analysis of peritoneal fluid in staging laparoscopy of gastric cancer is performed to improve the detection of free intraperitoneal tumor cells. Nevertheless, its significance is controversial, especially in patients with negative cytology but positive molecular analysis.

The aim of this study was to analyze the sensitivity of molecular analysis and its prognostic value.

Methods

A retrospective analysis from April 2011 to October 2019 was performed. Cytology (Cyt) and molecular analysis were analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) of the carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) tumor makers.

Results

During the study period, 138 staging laparoscopies were performed. Macroscopic carcinomatosis was found in 12.3%. Of the remaining 87.7%, 9.9% were Cyt + and 11.6% were Cyt- RT-PCR + . Of the latter, 9 responded to chemotherapy and underwent radical surgery. The sensitivity of cytology and molecular analysis was 0.70 and 0.76, respectively (p = 0.67).

The 2-year overall survival (OS) of Cyt- RT-PCR + vs. Cyt + was similar (p = 0.1). The 2-year OS of Cyt-RT-PCR + subgroup who underwent radical surgery vs. Cyt-RT-PCR- patients was similar (p = 0.69), but disease-free survival was shorter in the first group (p = 0.005).

Conclusion

Our results show that the sensitivity of molecular analysis is similar to that of cytology. The prognostic value of positive molecular analysis was similar to positive cytology in terms of 2-year overall survival, except in the subgroup of operated patients in whom the overall survival was similar to that of those with a negative molecular analysis, albeit with a shorter disease-free survival.

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Acknowledgements

The authors thank D. Pringle for reviewing the final draft of the manuscript for its content and English style. The authors would like to thank the IDIBELL Foundation for the institutional support provided.

Funding

This study was supported by the Institut d’Investigació Biomèdica de Bellvitge (IDIBELL Foundation) (structural funding).

Author information

Authors and Affiliations

  1. Unit of Esophagogastric Surgery, General and Digestive Surgery Service, Bellvitge University Hospital, St Feixa Llarga s/n, l’Hospitalet del Llobregat, Barcelona, 08907, Spain

    M. Miró, R. Vives, L. Farran, F. Estremiana, C. Bettonica & H. Aranda

  2. General and Digestive Surgery Service, Bellvitge University Hospital, L’Hospitalet del Llobregat, Barcelona, Spain

    L. Secanella

  3. Pathology Department, Bellvitge University Hospital, L’Hospitalet del Llobregat, Barcelona, Spain

    M. Varela & N. Baixeras

  4. Medical Oncology Service, Institut Catala d’Oncologia, Gran Via de L’Hospitalet 199-203, L’Hospitalet del Llobregat, Barcelona, 08908, Spain

    M. Galán

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Contributions

Miró M: protocol, data collection, data analysis, manuscript writing. Vives R: data collection, manuscript writing. Farran L: protocol, final revision. Secanella L: protocol, data analysis. Varela M and Baixeras N: cytology and molecular analysis, manuscript writing. Estremiana F, Bettonica C and Aranda H: protocol, data collection, final revision. Galán M: protocol, final revision. All authors approved the submitted version.

Corresponding author

Correspondence to M. Miró.

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Ethics approval

Written informed consent was considered not necessary for the study as it was a retrospective analysis of our usual everyday work. Data of patients were anonymized for the purposes of this analysis. The confidential information of the patients was protected according to European regulations. This manuscript has been revised for its publication by the Research Ethics Committee of Bellvitge University Hospital.

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The authors declare no competing interests.

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Miró, M., Vives, R., Farran, L. et al. Utility of Molecular Analysis of Peritoneal Fluid in Staging Laparoscopy of Advanced Esophagogastric Junction and Gastric Cancer Prior to Neoadjuvant Treatment. J Gastrointest Canc 54, 651–661 (2023). https://doi.org/10.1007/s12029-022-00846-8

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