Abstract
Purpose
Peritoneal recurrence is not an uncommon cause of death after surgery for gastric cancer, even after surgery with curative intent. This indicates that there is undetected residual disease in the peritoneal cavity. We conducted this study to determine the value of peritoneal and serum carcinoembryonic antigen (CEA) levels and peritoneal washing cytology in predicting the locoregional and distant spread of gastric cancer.
Methods
We prospectively evaluated 70 consecutive patients with gastric cancer by measuring peritoneal CEA (pCEA) and serum CEA (sCEA) levels and peritoneal washing cytology results, and studying their effect on the histopathologic properties. The effect of the pCEA level on disease-free survival (DFS) and overall survival (OS) was also evaluated in patients treated with curative intent.
Results
Twenty-one (30%) patients had sCEA levels >10 ng/ml, whereas 25 patients (35.7%) had pCEA levels >10 ng/g protein and 26 patients (37.1%) had positive cytology. The pCEA levels were significantly higher in patients with hepatic metastases (P = 0.034), or serosal (P = 0.028), and peritoneal (P = 0.026) involvement, whereas the sCEA levels were significantly higher only in patients with hepatic metastases (P = 0.04). Similarly, positive cytology was mainly detected in patients with hepatic metastases (P = 0.004). The pCEA levels significantly affected DFS (P = 0.002) and OS (P = 0.01) in 34 patients treated with curative intent.
Conclusion
Since pCEA levels are more useful for predicting locoregional recurrence, their measurement during surgery may help plan the most appropriate surgical strategy and adjuvant therapy.
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References
LH Sobin C Wittekind (Eds) (1997) TNM classification of malignant tumors EditionNumber5th ed. Wiley New York
T Boku Y Nakane T Minoura H Takada M Yamamura K Hioki et al. (1990) ArticleTitlePrognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer Br J Surg 77 436–9 Occurrence Handle2340396
E Bando Y Yonemura Y Takeshita K Taniguchi T Yasui Y Yoshimitsu et al. (1999) ArticleTitleIntraoperative lavage for cytological examination in 1 297 patients with gastric carcinoma Am J Surg 178 256–62 Occurrence Handle10.1016/S0002-9610(99)00162-2 Occurrence Handle10527450
S Abe H Yoshimura H Tabata M Tachibana N Monden T Nakamura et al. (1995) ArticleTitleCurative resection of gastric cancer: limitation of peritoneal lavage cytology in predicting the outcome J Surg Oncol 59 226–9 Occurrence Handle7630168
T Asao T Fukuda S Yazawa Y Nagamachi (1989) ArticleTitleCEA levels in peritoneal washings from gastric cancer patients as a prognostic guide Cancer Lett 47 79–81 Occurrence Handle10.1016/0304-3835(89)90180-8 Occurrence Handle2636035
T Asao T Fukuda S Yazawa Y Nagamachi (1991) ArticleTitleCarcinoembryonic antigen levels in peritoneal washings can predict peritoneal recurrence after curative resection of gastric cancer Cancer 68 44–7 Occurrence Handle2049751
N Abe T Watanabe H Toda H Machida K Suzuki T Masaki et al. (2001) ArticleTitlePrognostic significance of carcinoembryonic antigen levels in peritoneal washes in patients with gastric cancer Am J Surg 181 356–61 Occurrence Handle10.1016/S0002-9610(01)00585-2 Occurrence Handle11438272
RH Fletcher (1986) ArticleTitleCarcinoembryonic antigen Ann Intern Med 104 66–73 Occurrence Handle3510056
JJ Bonenkamp I Songun J Hermans CJH van de Velde (1996) ArticleTitlePrognostic value of positive cytology findings from abdominal washings in patients with gastric cancer Br J Surg 83 672–4 Occurrence Handle8689216
M Nishiyama I Takashima T Tanaka K Yoshida T Toge N Nagata et al. (1995) ArticleTitleCarcinoembryonic antigen levels in peritoneal cavity: useful guide to peritoneal recurrence and prognosis for gastric cancer World J Surg 19 133–7 Occurrence Handle10.1007/BF00316997 Occurrence Handle7740800
T Irinoda M Terashima A Takagane N Sasaki K Abe M Araya et al. (1998) ArticleTitleCarcinoembryonic antigen levels in peritoneal washings is a prognostic factor in patients with gastric cancer Oncol Rep 5 661–6 Occurrence Handle9538172
Y Kodera H Nakanishi Y Yamamura Y Shimizu A Torii T Hirai et al. (1998) ArticleTitlePrognostic value and clinical implications of disseminated cancer cells in the peritoneal cavity detected by reverse transcriptase-polymerase chain reaction and cytology Int J Cancer 79 429–33 Occurrence Handle10.1002/(SICI)1097-0215(19980821)79:4<429::AID-IJC20>3.0.CO;2-Z Occurrence Handle9699538
H Nakanishi Y Kodera A Torii T Hirai Y Yamamura T Kato et al. (1997) ArticleTitleDetection of carcinoembryonic antigen-expressing free tumor cells in peritoneal washes from patients with gastric carcinoma by polymerase chain reaction Jpn J Cancer Res 88 687–92 Occurrence Handle9310142
H Nakanishi Y Kodera Y Yamamura S Ito T Kato T Ezaki et al. (2000) ArticleTitleRapid quantitative detection of carcinoembryonic antigen-expressing free tumor cells in the peritoneal cavity of gastric-cancer patients with real-time RT-PCR on the lightcycler Int J Cancer 89 411–7 Occurrence Handle10.1002/1097-0215(20000920)89:5<411::AID-IJC3>3.0.CO;2-5 Occurrence Handle11008202
N Kojima K Kunieda K Matsui H Kato S Saji (2003) ArticleTitleEvaluation of carcinoembryonic antigen mRNA in living, necrotic, and apoptotic gastric cancer cells by reverse transcriptase-polymerase chain reaction Surg Today 33 839–46 Occurrence Handle10.1007/s00595-003-2617-0 Occurrence Handle14605956
Y Yonemura I Ninomiya M Kaji K Sugiyama K Fujimura K Sawa et al. (1995) ArticleTitleProphylaxis with intraoperative chemohyperthermia against peritoneal recurrence of serosal invasion-positive gastric cancer World J Surg 19 450–5 Occurrence Handle10.1007/BF00299188 Occurrence Handle7639005
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Çetin, B., Atalay, C., Aslan, S. et al. Peritoneal Carcinoembryonic Antigen Level for Predicting Locoregional and Distant Spread of Gastric Cancer. Surg Today 35, 919–924 (2005). https://doi.org/10.1007/s00595-005-3057-9
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DOI: https://doi.org/10.1007/s00595-005-3057-9