title: Cancer cells with p53 deletion detected by fluorescent in situ hybridization in peritoneal drainage fluid is correlated with early peritoneal seeding in resectable pancreatic cancer.
abstract: OBJECTIVE
  Free tumor cells in peritoneal fluid in patients with pancreatic cancer may have prognostic significance but there are few reports on methods for the effective detection of free tumor cells. The aims of this study were to identify free cancer cells in peritoneal fluid with fluorescent in situ hybridization (FISH) technique and to investigate its prognostic significance.
  
  
  METHODS
  Twenty-eight patients with resectable pancreatic cancer who underwent surgical resection were included. Peritoneal washing and peritoneal drainage fluid were examined by FISH for p53 deletion.
  
  
  RESULTS
  Among the study subjects, the R0 resection rate was 75%. None of the patients had positive cytology with Papanicolaou's method. p53 deletion was detected in 9 peritoneal washings (32.1%) and in 5 peritoneal drainage fluids (17.9%). After a median of 18 months of follow-up, 25 patients (89.3%) experienced recurrence and 14 patients (50.0%) had peritoneal seeding. Patients with p53 deletion detected in the peritoneal drainage fluid had positive radial margin (60.0% vs. 17.4%, P = 0.046) more frequently and a lower peritoneal metastasis free survival (median, 11.1 months vs. 30.3 months; P = 0.030). Curative resection (P < 0.001) and p53 deletion in peritoneal drainage fluid (P = 0.030) were independent risk factors of peritoneal metastasis free survival after multivariate analysis.
  
  
  CONCLUSIONS
  FISH technique detects free cancer cells with higher sensitivity compared to Papanicolaou's method. p53 deletion detected in peritoneal drainage fluid is correlated with positive radial resection margin and results in early peritoneal seeding. Patients with p53 deletion in peritoneal drainage fluid need more aggressive adjuvant treatment.
authors.affiliation: Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Park
authors.forename: Wooil
authors.initials: W
authors.lastname: Kwon
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
keywords: Fluorescent in situ hybridization; Pancreatic neoplsms; Peritoneal fluid; p53 gene