title: Presence of minute cancer cell dissemination in peritoneal lavage fluid detected by reverse transcription PCR is an independent prognostic factor in patients with resectable pancreatic cancer.
abstract: BACKGROUND
  Presence of minute cancer cell dissemination in peritoneal lavage fluid detected by reverse transcription polymerase chain reaction (RT-PCR) has been reported to be a reliable predictor of the prognosis in several kinds of cancers, but has not been determined in pancreatic cancer.
  
  
  METHODS
  Peritoneal lavage fluid was harvested just after a laparotomy in 83 patients with adenocarcinoma of the pancreas. Half of the fluid was examined by cytology and the remaining half was used to measure carcinoembryonic antigen/beta-2-microglobulin (beta2M) mRNA expression. Patients were followed after surgery to evaluate its clinical significance.
  
  
  RESULTS
  Among 83 patients, 3 were cytologically positive (CY+), while 23 were positive by RT-PCR (PCR+). Seventy-one patients underwent a surgical resection whereas 12 were unresectable. Because 2 were CY+ among the 71 operated patients, the remaining 69 CY- patients were further investigated. Among those 69 patients, PCR+ was observed in 15 patients, whose incidence of postoperative peritoneal recurrence was significantly higher than that in PCR- patients (21% vs 4% at 3 years; P = .039). Moreover, both the recurrence-free rate in the abdominal cavity (peritoneal or local recurrence, excluding liver metastases) and the overall survival rate were better in PCR- patients than PCR+ patients (78% vs 33%, P = .0045 and 67% vs 46%, P = .0151). A multivariate analysis revealed positive lymph node metastases (hazard ratio; 5.18) and positive RT-PCR (hazard ratio; 3.65) were independent prognostic factors.
  
  
  CONCLUSIONS
  The RT-PCR-based cancer cell detection was an independent prognostic factor in patients with resectable adenocarcinoma of the pancreas and had close association with local or peritoneal recurrence.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. hidetoshi-eguchi@nifty.com
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Seki
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Kunihito
authors.initials: K
authors.lastname: Goto
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Atushi
authors.initials: A
authors.lastname: Idota
authors.forename: Junko
authors.initials: J
authors.lastname: Fujii
authors.forename: Hiromu
authors.initials: H
authors.lastname: Nakajima
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D010533:Peritoneal Lavage; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D020133:Reverse Transcriptase Polymerase Chain Reaction