Prognostic impact of RT-PCR-based detection of peritoneal micrometastases in patients with pancreatic cancer undergoing curative resection.
BACKGROUND
Positive peritoneal fluid cytology predicts poor outcome in patients with resected pancreatic cancer. Reverse transcription-polymerase chain reaction (RT-PCR) has been proposed as a more sensitive means of detection of peritoneal micrometastases than conventional cytology. The clinical significance of RT-PCR positivity in the absence of other evidence of peritoneal disease is unknown. The purpose of the current study was to determine the outcome RT-PCR positive/cytology-negative patients who underwent potentially curative resection.


METHODS
Peritoneal washings were collected prospectively from 115 patients with pancreatic cancer undergoing diagnostic laparoscopy at a single institution. Specimens were analyzed by a cytopathologist and by RT-PCR for carcinoembryonic antigen (CEA).


RESULTS
Of the 115 patients, 62 (54%) underwent R0 resection. Eleven of the 62 patients (18%) had peritoneal washings that were negative by conventional cytology but positive for CEA by RT-PCR. Those 11 patients experienced early peritoneal and overall disease recurrence versus those who were RT-PCR negative (P = 0.001, P = 0.003, respectively) independent of nodal status.


CONCLUSIONS
RT-PCR for CEA is a sensitive and specific method for the detection of clinically significant peritoneal micrometastases from pancreatic cancer and it might identify a subgroup of patients with otherwise negative findings at staging laparoscopy who might respond better to treatment other than primary surgical resection.
Kelly
Kaitlyn J
KJ
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Wong
Joyce
J
Gladdy
Rebecca
R
Moore-Dalal
Kimberly
K
Woo
Yanghee
Y
Gonen
Mithat
M
Brennan
Murray
M
Allen
Peter
P
Fong
Yuman
Y
Coit
Daniel
D
D000230:Adenocarcinoma / Q000235:genetics / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000473:pathology; D002272:Carcinoembryonic Antigen / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000235:genetics / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction
D002272:Carcinoembryonic Antigen; D012333:RNA, Messenger