Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer / 부인종양

OBJECTIVE: Optimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS. METHODS: In total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS. RESULTS: NAC-treated patients had stage III–IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p < 0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p < 0.001). CONCLUSION: PWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.

Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis

Intraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells -positive patients had higher rates of nodal spread (risk difference: 0.29; p<0.01), serosal invasion (risk difference: 0.43; p<0.01), recurrence (after 60 months of follow-up, risk difference: 0.44; p<0.01), and mortality (after 60 months of follow-up, risk difference: 0.34; p<0.01). Intraperitoneal free cancer cells are associated with a poor outcome in gastric cancer. This surrogate biomarker should be used to guide therapy both prior to and after surgery.

A Prospective Study on the Significance of Peritoneal Washing Cytology as a Diagnostic Modality in Colorectal Cancer

PURPOSE: Free intraperitoneal cancer cells exfoliated from a tumor are considered to be responsible for peritoneal dissemination. Therefore, microscopic evaluation of cells washed from the peritoneal cavity during surgery for various intraabdominal malignancies has been used to detect subclinical intraperitoneal metastases from these tumors. The purposes of this study were to detect intraperitoneal free cancer cells at the time of surgery by using peritoneal washing cytology in colorectal cancer and to evaluate their diagnostic significance. METHODS: During the 29-month period from January 2000 through May 2002, 149 randomly selected patients with primary colorectal cancer without evidence of gross peritoneal metastasis underwent peritoneal washing cytologic analysis before surgical manipulation of the tumor. Peritoneal washing cytology was compared with the pre-existing prognostic factors. RESULTS: Positive peritoneal washing for free cancer cells was found in 19 of 149 patients (12.8%). This positivity was significantly correlated with histologic grade (P=0.002), serosal invasion (P=0.025), lymph node metastasis (P=0.034), Astler-Coller classification (P=0.008), recurrence (P<0.001), and 5-year survival (P<0.001). Cancer-specific survival was significantly associated with histologic grade (P=0.025), peritoneal washing cytology (P<0.001), lymph node metastasis (P<0.001), recurrence (P<0.001), and stage (P= 0.010) in the multivariate analysis. CONCLUSIONS: The presence of free cancer cells was predictive of survival and was an independent prognostic factor. This information may be useful in stratifying patients with colorectal cancer for therapeutic trials, such as intraperitoneal chemotherapy.

Clinical Significance of Measuring Levels of CEA, CA19-9 in Peritoneal Washing Fluid in Patients with Gastric Cancer

PURPOSE: Free cancer cells exfoliated from cancer-invaded serosa contribute to peritoneal dissemination, the most frequent pattern of recurrence in patients with gastric cancer. To detect free cancer cells, CEA and CA19-9 were introduced as the markers of gastric cancer, and many methods, such as cytology, immunoassay, and reverse transcription polymerase chain reaction (RT-PCR), exist for detecting them. The aim of this study is to define the clinical significance of using immunoassay to measure the levels of CEA and CA19-9 in the peritoneal washings in patients with gastric cancer. MATERIALS AND METHODS: The peritoneal washing fluids were obtained from 130 patients with gastric cancer who received a curative gastrectomy, palliative gastrectomy or open and closure. The pCEA and pCA19-9 levels were measured by using immunoassay and cytology. The results were compared with the clinicopathological data. RESULTS: The pCEA and pCA19-9 levels were correlated with tumor invasion, lymph-node metastasis, and stage (P<0.05). CONCLUSION: A correlation was found between elevated pCEA and pCA19-9 levels measured by immunoassay and the TNM stage. Therefore, a combined pCEA and pCA19-9 assay could be a sensitive detector of peritoneal dissemination, as well as a predictor of postoperative prognosis. pCEA and pCA19-9 may also determine the adjuvant management strategy.

Differential Diagnosis of Ovarian Mucinous, Serous, and Endometrioid Adenocarcinoma in Peritoneal Washing Cytology / 대한세포병리학회지

This study presents the cytologic features of peritoneal washings, with particular emphasis on the cytologic discrimination among serous, mucinous, and endometrioid adenocarcinoma of the ovary. We selected histologically confirmed 27 cases of peritoneal washing : 8 cases of serous cystadenocarcinomas, 5 cases of mucinous cystadenocarcinomas, and 14 cases of endometrioid adenocarcinomas. The most frequent cytologic pattern of three tumors was clusters. Ball pattern was found in serous cystadenocarcinoma(36%) and acinar pattern in endometrioid adenocarcinoma (36%). Mucinous adenocarcinoma showed mucoid background(100%) and endometrioid adenocarcinoma revealed inflammatory background(43%). The cytoplasmic vacuoles were noted in 80%, 13%, and 43% of mucinous, serous, and endometrioid adenocarcinoma, respectively. The endometrioid adenocarcinoma showed prominent nucleoli(64%). In conclusion, the cytologic findings of mucinous cystadenocarcinoma were different from that of serous and endometrioid carcinomas, such as mucoid background, abundant cytoplasm with vacuolated cytoplasm, and peripherally located cytoplasm. Although endometrioid carcinoma showed acinar pattern and prominent nucleoli, the differential diagnosis between serous cystadenocarcinoma and endometrioid adenocarcinoma in peritoneal washing cytology was not always possible.