Journal of Clinical Oncology, Vol 16, 3406-3411, Copyright © 1998 by American Society of Clinical Oncology
Diagnostic and prognostic value of peritoneal immunocytology in gastric cancer
M Benevolo, M Mottolese, M Cosimelli, M Tedesco, D Giannarelli, S Vasselli, M Carlini, A Garofalo and PG Natali
Regina Elena Cancer Institute, Rome, Italy.
PURPOSE: Among the clinical factors with a pivotal role in the prediction
of outcome for patients with gastric cancer, intraperitoneal (i.p.)
microscopic dissemination may represent an important cause of recurrences,
even in the early stages of the disease. In this context, the cytologic
examination of intraoperative peritoneal washings may be essential to
identify metastatic free cells, although a number of false- negative cases
may be encountered. PATIENTS AND METHODS: To determine whether
immunocytochemical (ICC) methods that used a panel of three monoclonal
antibodies (MoAbs), B72.3, AR3, and BD5, directed to gastric
cancer-associated antigens can improve peritoneal cytology by providing
more accurate prognostic indications, we immunocytochemically and
morphologically evaluated 144 peritoneal washings sampled from patients
surgically treated for gastric cancer. RESULTS: The ICC analysis allowed
the identification of metastatic free peritoneal cells in 35% of the
patients, with a 14% improvement over routine cytopathology (P < .0001).
Furthermore, a 54-month survival analysis by Kaplan-Meier curves showed a
statistically significant decrease in overall survival (OS) in patients
with stages I through III disease with peritoneal microscopic disease
detected morphologically and/or by ICC at the time of the primary surgery.
CONCLUSION: Our data indicate that the use of a combination of selected
MoAbs may allow the identification of cytologically false-negative cases
that provide valuable prognostic information. This may be useful to
stratify patients on more adequate therapeutic trials.
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