Free cancer cells in gastric cancer – methods of detection, clinical and prognostic importance (meta-analysis)

Kołomańska, Magdalena; Głuszek, Stanisław

doi:10.5114/wo.2020.94724

Cited by 4 publications

(4 citation statements)

References 27 publications

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“… 16 suggested that EIPL had no survival benefit for patients with GC undergoing curative gastrectomy. IPC has been reported to eliminate potential free cancer cells from the peritoneal cavity 20 . Several studies had found that IPC could reduce peritoneal metastases and improve the survival outcome of patients with GC 7 – 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Although peritoneal metastasis can be diagnosed, prediction of future postoperative relapse is different and more challenging in clinic. Cytologic examination of peritoneal lavage was used to determine peritoneal metastasis, but it was reported to be invasive, time consuming, and expensive 18 – 20 . Other conventional imaging modalities, including computed tomography (CT), positron emission tomography-computed tomography (PET-CT), or ultrasonography, yielded unsatisfactory accuracy for PR prediction 21 .…”

Section: Introductionmentioning

confidence: 99%

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Noninvasive imaging evaluation of peritoneal recurrence and chemotherapy benefit in gastric cancer after gastrectomy：a multicenter study

Sun¹,

Wang²,

Huang³

et al. 2023

International Journal of Surgery

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Background: Peritoneal recurrence (PR) is the predominant pattern of relapse after curative-intent surgery in gastric cancer (GC) and indicates a dismal prognosis. Accurate prediction of PR is crucial for patient management and treatment. The authors aimed to develop a noninvasive imaging biomarker from computed tomography (CT) for PR evaluation, and investigate its associations with prognosis and chemotherapy benefit. Methods: In this multicenter study including five independent cohorts of 2005 GC patients, the authors extracted 584 quantitative features from the intratumoral and peritumoral regions on contrast-enhanced CT images. The artificial intelligence algorithms were used to select significant PR-related features, and then integrated into a radiomic imaging signature. And improvements of diagnostic accuracy for PR by clinicians with the signature assistance were quantified. Using Shapley values, the authors determined the most relevant features and provided explanations to prediction. The authors further evaluated its predictive performance in prognosis and chemotherapy response. Results: The developed radiomics signature had a consistently high accuracy in predicting PR in the training cohort (area under the curve: 0.732) and internal and Sun Yat-sen University Cancer Center validation cohorts (0.721 and 0.728). The radiomics signature was the most important feature in Shapley interpretation. The diagnostic accuracy of PR with the radiomics signature assistance was improved by 10.13–18.86% for clinicians ( P <0.001). Furthermore, it was also applicable in the survival prediction. In multivariable analysis, the radiomics signature remained an independent predictor for PR and prognosis ( P <0.001 for all). Importantly, patients with predicting high risk of PR from radiomics signature could gain survival benefit from adjuvant chemotherapy. By contrast, chemotherapy had no impact on survival for patients with a predicted low risk of PR. Conclusion: The noninvasive and explainable model developed from preoperative CT images could accurately predict PR and chemotherapy benefit in patients with GC, which will allow the optimization of individual decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Noninvasive imaging evaluation of peritoneal recurrence and chemotherapy benefit in gastric cancer after gastrectomy：a multicenter study

Sun¹,

Wang²,

Huang³

et al. 2023

International Journal of Surgery

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“…PM is a frequent metastasis pattern in GC and remains a challenging clinical issue. In the era of precision therapy, ongoing research focuses on molecular characterization and biomarkers to predict PM ( Chen et al, 2020 ; Kolomanska & Gluszek, 2020 ). Diverse prediction models, including PET-CT radiomics features ( Xie et al, 2023 ) and those for late-stage GC occult PM ( Gao et al, 2023 ), are being explored.…”

Section: Introductionmentioning

confidence: 99%

Positive peritoneal lavage fluid cytology based on isolation by size of epithelial tumor cells indicates a high risk of peritoneal metastasis

Xuan,

Gao,

Wang

et al. 2024

PeerJ

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Background Peritoneal metastasis (PM) is the most prevalent type of metastasis in patients with gastric cancer (GC) and has an extremely poor prognosis. The detection of free cancer cells (FCCs) in the peritoneal cavity has been demonstrated to be one of the worst prognostic factors for GC. However, there is a lack of sensitive detection methods for FCCs in the peritoneal cavity. This study aimed to use a new peritoneal lavage fluid cytology examination to detect FCCs in patients with GC, and to explore its clinical significance on diagnosing of occult peritoneal metastasis (OPM) and prognosis. Methods Peritoneal lavage fluid from 50 patients with GC was obtained and processed via the isolation by size of epithelial tumor cells (ISET) method. Immunofluorescence and fluorescence in situ hybridization (FISH) were used to identify FCCs expressing chromosome 8 (CEP8), chromosome 17 (CEP17), and epithelial cell adhesion molecule (EpCAM). Results Using a combination of the ISET platform and immunofluorescence-FISH, the detection of FCCs was higher than that by light microscopy (24.0% vs. 2.0%). Samples were categorized into positive and negative groups, based on the expressions of CEP8, CEP17, and EpCAM. Statistically significant relationships were demonstrated between age (P = 0.029), sex (P = 0.002), lymphatic invasion (P = 0.001), pTNM stage (P = 0.001), and positivity for FCCs. After adjusting for covariates, patients with positive FCCs had lower progression-free survival than patients with negative FCCs. Conclusion The ISET platform highly enriched nucleated cells from peritoneal lavage fluid, and indicators comprising EpCAM, CEP8, and CEP17 confirmed the diagnosis of FCCs. As a potential detection method, it offers an opportunity for early intervention of OPM and an extension of patient survival.

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“…Many basic methods of peritoneal lavage analysis have been described in the literature: The classical cytology involving examination of a smear made from a cell pellet on the microscope slide and a pigment assessment conducted by an experienced pathologist ( 6 ), the immunohistochemical method using the reaction of antibodies against antigens present on cancer cells ( 7 ), the immunoenzymatic method assessing the CEA level in the supernatant after centrifugation of lavage fluid ( 8 ), and molecular methods involving the identification of cancer cell genes employing RT-PCR techniques ( 9 ). These methods differ in sensitivity and specificity in predicting peritoneal recurrence, and cytology remains the gold standard for peritoneal lavage examination ( 10 ) due to its simplicity in implementation, the short analysis time, low costs, and its high specificity in predicting peritoneal recurrence.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Peritoneal Fluid Examination for Free Cancer Cells in Patients Qualified for Surgery for Gastric Cancer

Cieśla

Lisiecki²,

Ławnicka

et al. 2021

Front. Surg.

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Background: Peritoneal lavage cytology in patients with gastric cancer may correlate with an unfavorable prognosis. This study evaluated the presence of free cancer cells in the peritoneal lavage of a population of patients with gastric cancer and its correlation with the outcome of surgical treatment.Methods: One hundred patients diagnosed with gastric or gastrointestinal junction adenocarcinoma underwent surgery. In all patients, a cytological and immunohistochemical analysis of peritoneal lavage was performed. Based on the presence of free cancer cells (fcc) at the cytological and immunohistochemical examination of peritoneal lavage, patients undergoing surgery for gastric cancer were divided into two groups: fcc (+) and fcc (–).Results: A total of 100 patients, 37 women, and 63 men with a median age of 65 years were included in the study. In the entire study group, 16 (16%) patients were positive for the presence of free cancer cells (fcc +) at peritoneal lavage examination. However, in the group of patients who underwent gastrectomy, fcc (+) was found in 10 out of 77 (13%) patients. The presence of cancer cells in peritoneal lavage was a strong predictive factor in an unfavorable outcome after surgery, and 1-year and 2-year patient survival was 34 and 0% in fcc (+) patients and 79 and 59% in fcc (–), respectively. Moreover, the presence of free cancer cells was associated with a five-fold increased risk of death within 2 years after surgery. When analyzing the group of patients undergoing R0/R1 surgery, this difference was even more significant (p < 0.0001).Conclusions: The presence of free cancer cells in peritoneal lavage may significantly affect the outcome of patients with gastric cancer. Radical surgery in patients with free cancer cells in the peritoneal lavage did not result in a survival advantage. Identification of free cancer cells could help for a better stratification of gastric cancer patients, identifying those patients who could better benefit from a radical surgical treatment, finally improving long-term survival.

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Free cancer cells in gastric cancer – methods of detection, clinical and prognostic importance (meta-analysis)

Cited by 4 publications

References 27 publications

Noninvasive imaging evaluation of peritoneal recurrence and chemotherapy benefit in gastric cancer after gastrectomy：a multicenter study

Noninvasive imaging evaluation of peritoneal recurrence and chemotherapy benefit in gastric cancer after gastrectomy：a multicenter study

Positive peritoneal lavage fluid cytology based on isolation by size of epithelial tumor cells indicates a high risk of peritoneal metastasis

Clinical Significance of Peritoneal Fluid Examination for Free Cancer Cells in Patients Qualified for Surgery for Gastric Cancer

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