Application of molecular diagnosis for detection of peritoneal micrometastasis and evaluation of preoperative chemotherapy in advanced gastric carcinoma.
BACKGROUND
In advanced gastric cancer, peritoneal recurrence is the main cause of death after curative surgical resection. The aim of this report was to describe a novel approach for quantitative genetic diagnosis using peritoneal lavage for the identification of patients at high risk for peritoneal recurrence and for evaluation of the clinical response to intraperitoneal chemotherapy in advanced gastric cancer.


METHODS
Nineteen patients with advanced gastric cancer who underwent staging laparoscopy and intraperitoneal chemotherapy before surgical resection or systemic chemotherapy between June 1999 and September 2001 were enrolled in this study. All peritoneal lavage specimens, collected at both staging laparoscopy and gastrectomy, were subjected to real-time quantitative genetic diagnosis.


RESULTS
The reverse transcriptase polymerase chain reaction (RT-PCR) values decreased in 8 cases, stabilized as negative in 5, and increased in 6 during therapy. Patients whose RT-PCR values diminished and were ultimately negative survived except for one, and all but one patient whose values increased during treatment died of recurrence.


CONCLUSIONS
Quantitative evaluation of genetic changes can provide accurate, useful information on the effects of preoperative intra-abdominal chemotherapy and overall prognosis for patients with advanced gastric cancer.
Mori
Takuji
T
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Japan.
Fujiwara
Yoshiyuki
Y
Sugita
Yurika
Y
Azama
Takashi
T
Ishii
Takaaki
T
Taniguchi
Kazuhiro
K
Yamazaki
Keiji
K
Takiguchi
Shuji
S
Yasuda
Takushi
T
Yano
Masahiko
M
Monden
Morito
M
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology*; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002945:Cisplatin / Q000627:therapeutic use; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D010535:Laparoscopy; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008819:Mice, Nude; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000556:secondary*; D010865:Pilot Projects; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology*
D002272:Carcinoembryonic Antigen; D016685:Mitomycin; D002945:Cisplatin