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Peritoneal Lavage CEA mRNA Levels Predict Conversion Gastrectomy Outcomes after Induction Chemotherapy with Intraperitoneal Paclitaxel in Gastric Cancer Patients with Peritoneal Metastasis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The outcome of gastric cancer patients with peritoneal metastasis remains poor. We treated these patients with intraperitoneal and intravenous paclitaxel plus oral S-1 (tegafur/gimeracil/oteracil), followed by gastrectomy in responders. We evaluated the clinical significance of peritoneal lavage carcinoembryonic antigen (CEA) messenger RNA (mRNA) levels as a biomarker for indication of conversion gastrectomy.

Methods

The peritoneal lavage of 68 patients who received the above regimen as induction chemotherapy was repeatedly collected via intraperitoneal access ports. Gastrectomy was considered when improvement of peritoneal metastasis was confirmed by a second laparoscopic examination with negative peritoneal cytology. CEA and porphobilinogen deaminase mRNAs were chronologically quantified using the transcription reverse-transcription concerted reaction method. The CEA mRNA index (CmRI) was calculated as CEA mRNA/porphobilinogen deaminase mRNA × 10,000.

Results

Thirty-nine patients underwent gastrectomy and 29 patients did not (median survival time, 27.8 vs. 10.7 months, respectively; P < 0.001). In gastrectomy-positive patients, the outcome largely differed according to CmRI values immediately prior to surgery. Patients with a preoperative CmRI value <100 (n = 20) were associated with a significantly longer survival than those with a preoperative CmRI value >100 (n = 19) (41.8 vs. 20.1 months, respectively; P < 0.001). A preoperative CmRI value <100 was confirmed as an independent predictor of survival for gastrectomy-positive patients in the multivariate analysis.

Conclusions

The CmRI reflects the response of peritoneal metastases to induction intraperitoneal chemotherapy. It may be a useful biomarker for indicating gastrectomy in gastric cancer patients with peritoneal metastasis.

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Authors and Affiliations

  1. Department of Clinical Oncology, Jichi Medical University, Tochigi, Japan

    Hironori Yamaguchi MD, PhD

  2. Department of Gastrointestinal Surgery, Jichi Medical University, Tochigi, Japan

    Hironori Yamaguchi MD, PhD & Joji Kitayama MD, PhD

  3. Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan

    Yumiko Satoh PhD, Makiko Kurihara PhD & Yutaka Yatomi MD, PhD

  4. Department of Chemotherapy, The University of Tokyo Hospital, Tokyo, Japan

    Hironori Ishigami MD

  5. Clinical Research Support Center, Jichi Medical University, Tochigi, Japan

    Joji Kitayama MD, PhD

Authors
  1. Hironori Yamaguchi MD, PhD
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  2. Yumiko Satoh PhD
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  3. Hironori Ishigami MD
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  4. Makiko Kurihara PhD
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  5. Yutaka Yatomi MD, PhD
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  6. Joji Kitayama MD, PhD
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Corresponding author

Correspondence to Hironori Yamaguchi MD, PhD.

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The authors have nothing to disclose.

Funding

This research was partially funded by a Grant from the Japan Agency for Medical Research and Development, and a KAKENHI Grant-in-Aid for Scientific Research (No. 15K10086) from the Japan Society for the Promotion of Science.

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Supplementary material 1 (TIFF 6079 kb)

Alterations in carcinoembryonic antigen (CEA) messenger RNA (mRNA) index values during induction chemotherapy in conversion gastrectomy patients with a preoperative CEA mRNA index value of (a) <100 (n = 20) or (b) >100 (n = 19). The x-axis represents the number of days since commencing induction chemotherapy. c Alterations in CEA mRNA index values during first-line chemotherapy up until the point of switching to second-line treatment in patients who did not undergo conversion gastrectomy (n = 29)

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Yamaguchi, H., Satoh, Y., Ishigami, H. et al. Peritoneal Lavage CEA mRNA Levels Predict Conversion Gastrectomy Outcomes after Induction Chemotherapy with Intraperitoneal Paclitaxel in Gastric Cancer Patients with Peritoneal Metastasis. Ann Surg Oncol 24, 3345–3352 (2017). https://doi.org/10.1245/s10434-017-5997-x

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  • DOI: https://doi.org/10.1245/s10434-017-5997-x

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