title: Prognostic significance of intraperitoneal cancer cells in gastric carcinoma: analysis of real time reverse transcriptase-polymerase chain reaction after 5 years of followup.
abstract: BACKGROUND
  The presence of gastric cancer cells in the peritoneal cavity detected by cytologic examination is an important prognostic factor. A reverse transcriptase-polymerase chain reaction (RT-PCR) technique amplifying carcinoembryonic antigen mRNA was recently introduced to detect these cells more sensitively.
  
  
  METHODS
  Five-year followup was completed for 284 gastric carcinoma patients who underwent CEA RT-PCR testing. Analyses to assess the accuracy and prognostic value of this procedure were performed, along with univariate and multivariable analyses to evaluate RT-PCR as a technique with peritoneal carcinomatosis and cancer death as the outcomes variables.
  
  
  RESULTS
  CEA mRNA levels exceeded the cutoff value defining a positive result in 9.5%, 29%, 66%, and 81% of patients with pT1, pT2, pT3, and pT4 stage disease, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for peritoneal carcinomatosis within 5 years of surgery were 88.5%, 81.6%, 64.5%, and 94.9%, respectively. Multivariable analysis revealed that a positive CEA mRNA result was an independent risk factor for cancer death (hazard ratio 2.82, 95% CI 1.17 -3.07) among 274 patients (10 patients with no record of nodal status were excluded from the analysis) and for peritoneal carcinomatosis (hazard ratio 1.57, 95% CI 1.07-2.29) among 242 patients who had no peritoneal deposits at operation.
  
  
  CONCLUSIONS
  CEA RT-PCR is useful as a prognostic marker for increased risk of cancer death and peritoneal carcinomatosis, and might be useful in the clinical setting for selecting patients for various adjuvant treatments.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Hayao
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Seiji
authors.initials: S
authors.lastname: Ito
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Norifumi
authors.initials: N
authors.lastname: Ohashi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yamamura
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.forename: Masae
authors.initials: M
authors.lastname: Tatematsu
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000368:Aged; D002272:Carcinoembryonic Antigen / Q000032:analysis / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012333:RNA, Messenger / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000473:pathology*
chemical_list: D002272:Carcinoembryonic Antigen; D012333:RNA, Messenger