Analyzing Gastric Lavage of Gastric Cancer Patients: A Prospective Observational Study on Cytopathology and Determination of Intragastric CEA, CA 19.9, CA 72.4, and CA 50

Abstract

Objectives: To investigate gastric lavage (GL) cytopathology and immunometric analysis as novel clinicopathologic and prognostic parameters for gastric cancer (GC). Study Design: In 38 patients with gastric adenocarcinoma, we performed a cytopathologic analysis and an immunometric assay of GL using four tumor markers (CEA, CA 19.9, CA 72.4, and CA 50). The intragastric tumor marker levels were compared with a control group consisting of 41 non-GC patients to determine a statistically significant cutoff value. Results: GL cytopathology demonstrated the presence of cancer cells in 13 (34.2%) of the 38 GC patients: such a finding correlated to the parameters pT and pN with a statistically significant validity (p < 0.0267 and p < 0.0306, respectively). Measurement of intragastric CA 19.9 and CA 50 attained a statistically significant cutoff value (p < 0.002 and p < 0.0096, respectively), which was invalidated by the low sensitivity of the ROC curve analysis. Conclusions: In contrast to determination of its tumor markers, GL cytopathology correlated well with pT and pN staging parameters. Should this and other features be corroborated by future studies, the GL cytology test could be routinely used to detect aggressive types of GC even at early stages and result in important progress in the knowledge, staging, prediction, as well as management and follow-up of this inauspicious type of cancer.

Identification of DNA mutations in gastric washes from gastric adenocarcinoma patients: Possible implications for liquid biopsies and patient follow‐up

“…GW has been investigated by very few studies as a means to support patient management. Virgilio et al 25 found tumor cells in the GW of GAC patients (34.2%, 13/38 cases) after the cytopathological examination, as well as an elevated concentration of tumor markers (CA 19-9 and CA-50), compared to controls. Watanabe et al 42 evaluated 20 patients with GAC and found a specific deletion of the TP53 gene in both the primary tumor and the respective GW in one case.…”

“…GW has been investigated by very few studies as a means to support patient management. Virgilio et al . found tumor cells in the GW of GAC patients (34.2%, 13/38 cases) after the cytopathological examination, as well as an elevated concentration of tumor markers (CA 19–9 and CA‐50), compared to controls.…”

“…As GW fluids are in intimate contact with the gastric mucosa (normal or neoplastic), they represent a possible source of valuable biomarkers, including ctDNA . However, very few studies have focused on the use of GWs as a source of tumor markers and most were limited to the identification of proteins, tumor cells, extracellular vesicles, microRNAs and lncRNAs or cytological markers . To our knowledge, the results presented here are the first to demonstrate tumor‐derived mutations in the DNA from the GW of GAC patients using next‐generation DNA sequencing (NGS).…”

“…22 However, very few studies have focused on the use of GWs as a source of tumor markers and most were limited to the identification of proteins, tumor cells, extracellular vesicles, microRNAs and lncRNAs or cytological markers. [22][23][24][25][26][27][28] To our knowledge, the results presented here are the first to demonstrate tumorderived mutations in the DNA from the GW of GAC patients using next-generation DNA sequencing (NGS). Our results highlight the potential of GW as a relevant source for detecting GAC mutations and its potential utility for tracking tumor dynamics, patient prognosis and treatment efficiency.…”

Presence of cancer cells in gastric lavage of gastric cancer patients as an indicator of advanced disease, predictor of tumour aggressive phenotype and independent prognostic factor for poor survival: The endoluminal metastatic pathway of gastric cancer and GL0/GL1 classification

“…Between April 2012 and September 2016, 80 patients with a preoperative histology of gastric adenocarcinoma were recruited for this prospective observational study in compliance with the principles embodied in the Declaration of Helsinki. Informed consent was obtained prior to enrolment; 38 subjects were included in a previous study on GC . All participants were fitted with a nasogastric (NG) tube during their hospital stay at the Division of General and Emergency Surgery of St Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University, Rome, Italy.…”