[Effect of surgical manipulation on the dissemination of cancer cells into peripheral blood in patients with gastric cancer and its risk factor analysis].
OBJECTIVE
To evaluate the effect of surgical manipulation on the dissemination of cancer cells into blood circulation in patients with gastric cancer and to analyze its risk factors.


METHODS
This study included 45 consecutive patients with gastric cancer undergoing curative resection and 13 control cases (10 healthy persons and 3 patients with peptic ulcer receiving gastrectomy). Peripheral blood was obtained preoperatively and just after surgical manipulation. The mRNA levels of carcinoembryonic antigen (CEA) from the blood samples were assayed by reverse transcription-polymerase chain reaction(RT-PCR) and compared between the 2 groups.


RESULTS
CEA mRNA was negative in all control cases. Of the 45 gastric cancer patients, the preoperative positive rate of CEA mRNA was 8.9%, while the postoperative positive rate was 48.9%, which was significantly higher than that of preoperation (P=0.000). Multivariable Logistic regression analysis showed that operative duration (P=0.014) and tumor depth (P=0.010) were independent risk factors for cancer cell dissemination. Furthermore, the operative duration in patients with positive postoperative CEA mRNA was markedly longer than that in patients with negative postoperative CEA mRNA (P=0.000), and positive rate of postoperative CEA mRNA in advanced gastric cancer was higher compared with that in early gastric cancer (P=0.034).


CONCLUSIONS
Surgical manipulation of curative gastrectomy can provoke dissemination of cancer cells into blood circulation, and the operative duration and tumor invasion depth may be 2 of the risk factors for cancer cell dissemination.
Zhang
Jing-ping
JP
Department of General Surgery, Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou 213003, China. zcfmlm@yahoo.com.cn
Zhu
Chun-fu
CF
Wang
Ke-jun
KJ
Xu
Hao
H
Wang
Shi-zhong
SZ
Zhu
Ping
P
Gao
Xiang
X
Wu
Wen-ze
WZ
D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D012333:RNA, Messenger / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*
D002272:Carcinoembryonic Antigen; D012333:RNA, Messenger