Cancer cells with p53 deletion detected by fluorescentin situhybridization in peritoneal drainage fluid is correlated with early peritoneal seeding in resectable pancreatic cancer

Abstract

PurposeFree tumor cells in peritoneal fluid in patients with pancreatic cancer may have prognostic significance but there are few reports on methods for the effective detection of free tumor cells. The aims of this study were to identify free cancer cells in peritoneal fluid with fluorescent in situ hybridization (FISH) technique and to investigate its prognostic significance.MethodsTwenty-eight patients with resectable pancreatic cancer who underwent surgical resection were included. Peritoneal washing and peritoneal drainage fluid were examined by FISH for p53 deletion.ResultsAmong the study subjects, the R0 resection rate was 75%. None of the patients had positive cytology with Papanicolaou's method. p53 deletion was detected in 9 peritoneal washings (32.1%) and in 5 peritoneal drainage fluids (17.9%). After a median of 18 months of follow-up, 25 patients (89.3%) experienced recurrence and 14 patients (50.0%) had peritoneal seeding. Patients with p53 deletion detected in the peritoneal drainage fluid had positive radial margin (60.0% vs. 17.4%, P = 0.046) more frequently and a lower peritoneal metastasis free survival (median, 11.1 months vs. 30.3 months; P = 0.030). Curative resection (P < 0.001) and p53 deletion in peritoneal drainage fluid (P = 0.030) were independent risk factors of peritoneal metastasis free survival after multivariate analysis.ConclusionFISH technique detects free cancer cells with higher sensitivity compared to Papanicolaou's method. p53 deletion detected in peritoneal drainage fluid is correlated with positive radial resection margin and results in early peritoneal seeding. Patients with p53 deletion in peritoneal drainage fluid need more aggressive adjuvant treatment.

Tumor manipulation during pancreatic resection for pancreatic cancer induces dissemination of tumor cells into the peritoneal cavity: a systematic review

“…26 Two studies were assessed as having moderate risk of bias on several domains 27,28 and one study as having moderate to high risk of bias on several domains. 29 It was uncertain whether patients were selected based on a sequential cohort in two studies 27,28 and no exclusion criteria were described in two studies. 27,29 No definition was presented of the secondary outcomes overall survival, disease free survival or peritoneal metastases free survival in two studies.…”

“…29 It was uncertain whether patients were selected based on a sequential cohort in two studies 27,28 and no exclusion criteria were described in two studies. 27,29 No definition was presented of the secondary outcomes overall survival, disease free survival or peritoneal metastases free survival in two studies. 28,29 No correction was made for confounders in the statistical analysis in three studies [27][28][29] and no information was presented on a possible important confounder, (neo)adjuvant chemo(radiation)therapy, in two studies.…”

“…27,29 No definition was presented of the secondary outcomes overall survival, disease free survival or peritoneal metastases free survival in two studies. 28,29 No correction was made for confounders in the statistical analysis in three studies [27][28][29] and no information was presented on a possible important confounder, (neo)adjuvant chemo(radiation)therapy, in two studies. 27,29 One study did not describe its statistical analyses at all.…”

“…28,29 No correction was made for confounders in the statistical analysis in three studies [27][28][29] and no information was presented on a possible important confounder, (neo)adjuvant chemo(radiation)therapy, in two studies. 27,29 One study did not describe its statistical analyses at all. 29…”

A strategy for improving FDG accumulation for early detection of metastasis from primary pancreatic cancer: Stimulation of the Warburg effect in AsPC-1 cells

“…Retrospective analysis has demonstrated that a dramatic change in surgical resectability and patient survival occurs as the size of the PC tumor increases from 20 mm to 30 mm [2,3]. Moreover, PC patient survival is dependent on distant metastasis rather than local recurrence, and therefore, early detection and/or prediction of metastasis provide more prognostic relevance than local recurrence [4].…”