Carcinoembryonic antigen levels in peritoneal washings can predict peritoneal recurrence after curative resection of gastric cancer

Abstract

Carcinoembryonic antigen (CEA) levels were determined in the peritoneal washings from 120 patients with gastric cancer and 9 patients with benign diseases. Elevated values (> 100 ng/g of protein) were observed in 20 of 25 patients with gastric cancer with visible dissemination and 16 of 25 patients with serosal invasion but no dissemination. The same elevation was found in only 9 of 70 patients with no serosal invasion and none of the patients with benign disease. The &year survival rates after curative operation for the patients with and without elevation of CEA levels were 21% (19 patients) and 100% (66 patients), respectively (P < 0.001). A negative correlation was found between CEA levels and survival times after noncurative operation. These results indicate that the CEA level in peritoneal washings could be a sensitive detector of invisible peritoneal dissemination and a new predictor for the postoperative prognosis of gastric cancer. Cancer 68:44-47,1991. ESPITE PROGRESS in surgical techniques and adju-D vant chemotherapies for gastric cancer, the surgical prognosis of the advanced cancer has not been improved.' Peritoneal metastasis continues to be the most frequent type of recurrence in patients who had no evidence of residual tumor at the time of surgery and it is a significant obstacle in the curative treatment of gastric cancer. Peri-toneal recurrence after curative resection of malignant tumor was considered to be caused by microscopic dissemination of cancer cells from the primary tumor invaded serosal surface.2 The exfoliated cancer cells were reported to be detected by cytologic examination of the peritoneal washings obtained at the time of l a p a r o t ~ m y. ~. ~ However, as many as 50% of the patients who died of peritoneal recurrence after curative resection of malignant tumor were also reported to have negative cytologic find-From the First

Prognostic significance of peritoneal washing cytology in Thai patients with gastric adenocarcinoma undergoing curative D2 gastrectomy

“…False-positive PWC has also been recognized, with a rate of 4.5%-5.0%, probably due to the presence of reactive mesothelial cells [20,21,26]. To reduce the false-negative rate, several authors have introduced more sensitive methods for detecting peritoneal dissemination, including immunohistochemistry and molecular biology techniques such as reverse transcriptase-polymerase chain reaction (RT-PCR) for expressing carcinoembryonic antigen (CEA) mRNA [20,24,[27][28][29][30] or trypsinogen mRNA [31] in the peritoneal washing fluid. However, these techniques are timeconsuming, expensive, and laborious compared with conventional cytology.…”

A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP)

“…Therefore, patients should be selected by sensitive laboratory tests to predict peritoneal metastasis. Asao et al [13] reported that carcinoembryonic antigen (CEA) levels in peritoneal washings could predict peritoneal recurrence after curative resection of gastric carcinoma. In our previous study [14], we also foured that CEA in peritoneal washings was more sensitive and more specific for predicting nonvisible peritoneal carcinoma cells than blood CEA levels or cytology.…”

Níveis dos marcadores CEA e CA 19-9 no soro e no lavado peritoneal na avaliação do comprometimento linfonodal do carcinoma gástrico

“…Realizou-se a determinação no lavado peritoneal dos níveis dos marcadores tumorais CEA e CA 19-9 ao término do procedimento operatório, pois é descrito que a manipulação da neoplasia e a realização da linfadenectomia nas operações curativas poderiam facilitar o acesso dos marcadores à cavidade abdominal propiciando níveis mais representativos dessas substâncias [16][17]19 .…”

“…A produção do CEA pela neoplasia primária ou por metástases possivelmente presentes no organismo pode ter influência no nível peritoneal do CEA por intermédio da circulação sistêmica [16][17]19 .…”