术中腹腔灌洗液检测对胃癌患者预测腹膜转移及判断预后的临床价值  

Value of cytology and carcinoembryonic antigen levels in peritoneal washes in predicting peritoneal metastasis and prognosis after curative resection of gastric cancer

作　　者：李继坤[1] 郑淼[1] 周立生[1] 武文森[2] 

机构地区：[1]上海市第一人民医院外科,200080 [2]上海市第一人民医院病理科,200080

出　　处：《中华胃肠外科杂志》2003年第5期326-328,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 探讨术中腹腔灌洗液细胞学检测(peritoneal lavage cytology,PLC)和癌胚抗原蛋白测定(pCEA)对胃癌患者术后预测腹膜转移及判断预后的价值。方法 术中采集57例进展期胃癌患者和8例胃良性疾病患者的腹腔灌洗液,进行细胞学检测和放射免疫法测定pCEA水平。结果 胃癌患者腹腔液pCEA阳性率(43.9％)明显高于PLC(26.3％)(P<0.05),PLC和pCEA阳性率与肿瘤浸润深度和淋巴结转移密切相关(P<0.05～0.01)。与PLC相比,pCEA对胃癌术后预测腹膜转移有较高的敏感度(94.7％)和较低的假阴性率(5.3％)。PLC阳性组及pCEA阳性组术后1、3、5年生存率均明显低于PLC阴性组及pCEA阴性组(P<0.05)。多因素分析表明pCEA是影响胃癌患者生存率的独立预后因素。结论 对于胃癌患者术后腹膜转移的预测和预后判断,术中pCEA测定是一种较PLC更加灵敏、可靠的指标。Objective To evaluate the usefulness of peritoneal lavage cytology (PLC) and CEA levels (pCEA) in predicting peritoneal metastasis and prognosis after curative resection of gastric cancer. Methods Cytologic examination and CEA level determination by radioimmunoassay were performed in peritoneal washes from 57 patients with advanced gastric cancer and 8 patients with benign diseases. Results The positive rate of pCEA (43.9%) was significanfiy higher than that of PLC (26.3%) (P<0.05). The positive rates of PLC and pCEA were significantly correlated with the depth of tumor invasion and lymph node metastasis(P<0.05～0.01). pCEA was found to have a higher sensitivity and a lower false-positive rate in predicting peritoneal metastasis after curative resection of gastric cancer as compared with PLC. The 1-, 3- and 5-year survival rates of the patients with positive cytologic findings or positive pCEA results were significantly lower than those of the patients with negative cytologic findings or negative pCEA results (P<0.05). Multivariate analysis indicated that pCEA was an independent prognostic factor for the survival of patients with gastric cancer. Conclusions Intraoperative pCEA could be a more sensitive and reliable predictor of peritoneal metastasis as well as prognosis in patients with gastric cancer as compared with PLC method.

关 键 词：术中 腹腔灌洗液 胃癌 预测 腹膜转移 预后 细胞学检测 放射免疫法 

分 类 号：R735.2[医药卫生—肿瘤]