Annals of Surgical Oncology

, Volume 24, Issue 11, pp 3345–3352 | Cite as

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

  • Hironori Yamaguchi
  • Yumiko Satoh
  • Hironori Ishigami
  • Makiko Kurihara
  • Yutaka Yatomi
  • Joji Kitayama
Gastrointestinal Oncology



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.


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.


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.


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.



The authors have nothing to disclose.


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.

Supplementary material

10434_2017_5997_MOESM1_ESM.tiff (5.9 mb)
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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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Hironori Yamaguchi
    • 1
    • 2
  • Yumiko Satoh
    • 3
  • Hironori Ishigami
    • 4
  • Makiko Kurihara
    • 3
  • Yutaka Yatomi
    • 3
  • Joji Kitayama
    • 2
    • 5
  1. 1.Department of Clinical OncologyJichi Medical UniversityTochigiJapan
  2. 2.Department of Gastrointestinal SurgeryJichi Medical UniversityTochigiJapan
  3. 3.Department of Clinical LaboratoryThe University of Tokyo HospitalTokyoJapan
  4. 4.Department of ChemotherapyThe University of Tokyo HospitalTokyoJapan
  5. 5.Clinical Research Support CenterJichi Medical UniversityTochigiJapan

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