Prognostic significance of peritoneal minimal residual disease in gastric cancer detected by reverse transcription–polymerase chain reaction

✍ Scribed by K. Oyama; M. Terashima; A. Takagane; C. Maesawa

• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 148 KB
• Volume: 91
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.4455

✦ Synopsis

Abstract

Background

A sensitive method for detecting minimal residual disease in the peritoneal cavity by quantifying carcinoembryonic antigen (CEA) mRNA using real-time quantitative reverse transcription–polymerase chain reaction (RQ-RT–PCR) was developed. The clinical value of the method for predicting peritoneal recurrence in patients with gastric cancer was evaluated.

Method

A total of 195 patients with gastric cancer and 20 with asymptomatic cholecystolithiasis were included in the study. CEA mRNA expression in peritoneal washings (p-CEA mRNA) was measured by RQ-RT–PCR and normalized to glyceraldehyde-3-phosphate dehydrogenase mRNA expression. The cut-off level of p-CEA mRNA for gastric cancer was determined by examining p-CEA mRNA levels in patients with asymptomatic cholecystolithiasis.

Results

Fifty-five (28·2 per cent) of the 195 patients were p-CEA mRNA positive. The rate of p-CEA mRNA positivity correlated significantly with clinicopathological factors. In 163 patients who underwent curative surgery, overall survival and disease-free survival were significantly poorer in p-CEA mRNA-positive patients than in p-CEA mRNA-negative patients (P < 0·001). Cox regression analysis revealed that only p-CEA mRNA was a significant independent prognostic factor (P = 0·034). Multivariate logistic regression analysis showed that p-CEA mRNA was a significant independent risk factor for peritoneal recurrence (P = 0·027).

Conclusion

These results suggest that p-CEA mRNA is a reliable prognostic factor and predictor of peritoneal recurrence in gastric cancer.