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目的探讨胃癌患者腹腔游离癌细胞形成的相关因素及其与胃癌根治术后预后的关系。方法对61例胃癌手术患者施行术中腹腔冲洗液细胞学检测,分析其临床病理特征与腹腔游离癌细胞形成的相关性,通过多元回归分析和累积生存曲线分析预后及相关因素。结果61例胃癌患者腹腔冲洗液细胞学阳性率为36%,Ⅲ、Ⅳ期胃癌、浆膜受累、淋巴结受侵及血管癌栓、术后腹膜转移者阳性率分别为50%、47%、45%、65%、88%,明显高于Ⅰ、Ⅱ期胃癌(19%)、浆膜未侵(22%)、无淋巴结受侵(12%)、无血管瘤栓(18%)及其他转移者(33%)。腹腔游离癌细胞是胃癌预后的独立危险因素(RR=3·614,P=0·02),腹腔冲洗液细胞学阳性组的生存时间明显缩短(P<0·01)。结论腹腔游离癌细胞形成微转移灶是胃癌根治术后腹腔复发转移及预后的危险因素,术中腹腔冲洗液细胞学检测有助于判断预后。
Objective To investigate the related factors of formation of peritoneal free cancer cells in patients with gastric cancer and its relationship with the prognosis of gastric cancer after radical operation. Methods Sixty-one patients with gastric cancer underwent intraperitoneal fluid cytology. The correlation between the clinicopathological features and the formation of peritoneal free cancerous cells was analyzed. The prognosis and related factors were analyzed by multiple regression analysis and cumulative survival curve. Results The positive rate of peritoneal wash cytology in 61 gastric cancer patients was 36%. The positive rates of stage Ⅲ, Ⅳ gastric cancer, serosa involvement, lymph node invasion and vascular thrombosis were 50%, 47%, 45% (19%), serosal invasion (22%), no lymph node involvement (12%), no angioma thrombus (18%) and other metastases (33%). The peritoneal free cancerous cells were independent risk factors of gastric cancer prognosis (RR = 3.146, P = 0.02), and the survival time of peritoneal lavage cytology positive group was significantly shorter (P <0.01). Conclusions The formation of micrometastases in peritoneal free cancer cells is a risk factor for the recurrence, metastasis and prognosis of peritoneal cavity after radical operation of gastric cancer. Intraperitoneal washing fluid cytology can be helpful to judge the prognosis.