Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec;16(12):3333-9.
doi: 10.1245/s10434-009-0683-2. Epub 2009 Sep 18.

Prognostic impact of RT-PCR-based detection of peritoneal micrometastases in patients with pancreatic cancer undergoing curative resection

Kaitlyn J Kelly  1 , Joyce Wong, Rebecca Gladdy, Kimberly Moore-Dalal, Yanghee Woo, Mithat Gonen, Murray Brennan, Peter Allen, Yuman Fong, Daniel Coit
Affiliations

Prognostic impact of RT-PCR-based detection of peritoneal micrometastases in patients with pancreatic cancer undergoing curative resection

Kaitlyn J Kelly et al. Ann Surg Oncol. 2009 Dec.

Abstract

Background: Positive peritoneal fluid cytology predicts poor outcome in patients with resected pancreatic cancer. Reverse transcription-polymerase chain reaction (RT-PCR) has been proposed as a more sensitive means of detection of peritoneal micrometastases than conventional cytology. The clinical significance of RT-PCR positivity in the absence of other evidence of peritoneal disease is unknown. The purpose of the current study was to determine the outcome RT-PCR positive/cytology-negative patients who underwent potentially curative resection.

Methods: Peritoneal washings were collected prospectively from 115 patients with pancreatic cancer undergoing diagnostic laparoscopy at a single institution. Specimens were analyzed by a cytopathologist and by RT-PCR for carcinoembryonic antigen (CEA).

Results: Of the 115 patients, 62 (54%) underwent R0 resection. Eleven of the 62 patients (18%) had peritoneal washings that were negative by conventional cytology but positive for CEA by RT-PCR. Those 11 patients experienced early peritoneal and overall disease recurrence versus those who were RT-PCR negative (P = 0.001, P = 0.003, respectively) independent of nodal status.

Conclusions: RT-PCR for CEA is a sensitive and specific method for the detection of clinically significant peritoneal micrometastases from pancreatic cancer and it might identify a subgroup of patients with otherwise negative findings at staging laparoscopy who might respond better to treatment other than primary surgical resection.

PubMed Disclaimer

Figures

FIG. 1
FIG. 1
a Comparison of results of biopsy and peritoneal fluid cytology performed in staging laparoscopy with RT-PCR results in 115 patients with pancreatic adenocarcinoma. b 28% of patients were found to have unresectable disease at staging laparoscopy. An additional 17% of patients had CEA mRNA in peritoneal fluid detected by RT-PCR as their only evidence of metastatic disease
FIG. 2
FIG. 2
a Of 62 patients who underwent R0 resection, no patients had positive findings at staging laparoscopy but 11 patients had peritoneal fluid positive for CEA by RT-PCR. b 18% of patients who underwent R0 resection had evidence of micrometastatic disease to the peritoneum detected by RT-PCR for CEA mRNA
FIG. 3
FIG. 3
a and b Kaplan-Meier curves demonstrate significantly increased incidence of early overall and peritoneal recurrence in RT-PCR positive patients (P = 0.003, P = 0.001; respectively). c Kaplan-Meier curve demonstrates a trend toward decreased disease-free survival in RT-PCR positive patients
See this image and copyright information in PMC

References

    1. House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12(2):270–8. - PubMed
    1. Williams TK, Rosato EL, Kennedy EP, et al. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg. 2009;208(2):210–7. - PubMed
    1. Bentrem DJ, Brennan MF. Outcomes in oncologic surgery: does volume make a difference? World J Surg. 2005;29(10):1210–6. - PubMed
    1. Mayo SC, Austin DF, Sheppard BC, et al. Evolving preoperative evaluation of patients with pancreatic cancer: does laparoscopy have a role in the current era? J Am Coll Surg. 2009;208(1):87–95. - PubMed
    1. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol. 2004;99(3):492–501. - PubMed

MeSH terms