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Role of peritoneal lavage cytology and prediction of prognosis and peritoneal recurrence after curative surgery for colorectal cancer.

Bae SJ, Shin US, Ki YJ, Cho SS, Moon SM, Park SH - Ann Coloproctol (2014)

Bottom Line: Among total 145 patients, six patients (4.1%) showed positive cytology.During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence.Among them, 5 patients (3.4%) showed peritoneal carcinomatosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

ABSTRACT

Purpose: In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.

Methods: From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.

Results: Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).

Conclusion: Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.

No MeSH data available.


Related in: MedlinePlus

(A) The malignant cells are arranged in 3-dimensional clusters with overlapping nuclei in the background of scattered reactive mesothelial cells, neutrophils and lymphocytes (Papanicolaou staining, ×400). (B) A tumor cell with high nuclear-to-cytoplasmic ratio has a hyperchromatic and coarse nucleus with an irregular eccentric contour and is 10 times larger than lymphocytes (Papanicolaou staining, ×400).
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Figure 1: (A) The malignant cells are arranged in 3-dimensional clusters with overlapping nuclei in the background of scattered reactive mesothelial cells, neutrophils and lymphocytes (Papanicolaou staining, ×400). (B) A tumor cell with high nuclear-to-cytoplasmic ratio has a hyperchromatic and coarse nucleus with an irregular eccentric contour and is 10 times larger than lymphocytes (Papanicolaou staining, ×400).

Mentions: All ThinPrep slides were reviewed and diagnosed by an experienced pathologist with a specialization in gastrointestinal oncology. A slide was classified as positive if malignant cells formed three-dimensional clusters or one malignant cell had a high nuclear cell ratio and over 10-fold enlargement compared to an adjacent lymphocyte (Fig. 1). A suspicion of malignancy or atypical finding was classified as negative.


Role of peritoneal lavage cytology and prediction of prognosis and peritoneal recurrence after curative surgery for colorectal cancer.

Bae SJ, Shin US, Ki YJ, Cho SS, Moon SM, Park SH - Ann Coloproctol (2014)

(A) The malignant cells are arranged in 3-dimensional clusters with overlapping nuclei in the background of scattered reactive mesothelial cells, neutrophils and lymphocytes (Papanicolaou staining, ×400). (B) A tumor cell with high nuclear-to-cytoplasmic ratio has a hyperchromatic and coarse nucleus with an irregular eccentric contour and is 10 times larger than lymphocytes (Papanicolaou staining, ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4286773&req=5

Figure 1: (A) The malignant cells are arranged in 3-dimensional clusters with overlapping nuclei in the background of scattered reactive mesothelial cells, neutrophils and lymphocytes (Papanicolaou staining, ×400). (B) A tumor cell with high nuclear-to-cytoplasmic ratio has a hyperchromatic and coarse nucleus with an irregular eccentric contour and is 10 times larger than lymphocytes (Papanicolaou staining, ×400).
Mentions: All ThinPrep slides were reviewed and diagnosed by an experienced pathologist with a specialization in gastrointestinal oncology. A slide was classified as positive if malignant cells formed three-dimensional clusters or one malignant cell had a high nuclear cell ratio and over 10-fold enlargement compared to an adjacent lymphocyte (Fig. 1). A suspicion of malignancy or atypical finding was classified as negative.

Bottom Line: Among total 145 patients, six patients (4.1%) showed positive cytology.During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence.Among them, 5 patients (3.4%) showed peritoneal carcinomatosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

ABSTRACT

Purpose: In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.

Methods: From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.

Results: Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).

Conclusion: Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.

No MeSH data available.


Related in: MedlinePlus