Quantitative detection of disseminated free cancer cells in peritoneal washes with real-time reverse transcriptase-polymerase chain reaction: a sensitive predictor of outcome for patients with gastric carcinoma

Ann Surg. 2002 Apr;235(4):499-506. doi: 10.1097/00000658-200204000-00007.


Objective: To evaluate the feasibility of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) detection of free cancer cells in the peritoneal washes as a prognostic indicator for patients with gastric carcinoma.

Summary background data: Peritoneal lavage cytology (CY) is an excellent prognostic determinant but lacks sensitivity. This can be improved by using RT-PCR to quantitate carcinoembryonic antigen (CEA) mRNA in peritoneal washes.

Methods: Peritoneal washes were obtained from 189 patients with gastric carcinoma during laparotomy. CEA mRNA levels and CEA/GAPDH mRNA ratios were quantified using a real-time PCR system with fluorescent hybridization probes. Receiver-operating characteristic plots were used to determine which of these parameters should be used as a marker for the intraperitoneal cancer cells. The prognostic significance of its positivity was then evaluated by Kaplan-Meier curves, and its value as an independent prognostic factor was evaluated by multivariate analysis.

Results: The sensitivity and specificity of real-time RT-PCR with an optimal cutoff value were 80% and 94%; those for conventional cytology were 56% and 91%. The survival of 16 patients who were CY-PCR+ was poor and approached that of 35 CY+ patients. Recurrence as peritoneal carcinomatosis was frequent among PCR+ patients but rare for their PCR- counterparts. PCR+ was a significant independent prognostic factor, along with the presence of node metastasis and serosal invasion, but CY+ was not.

Conclusions: Quantitative RT-PCR of peritoneal washes can replace cytologic examination as a tool for the sensitive evaluation of the risk of intraperitoneal recurrence in patients with gastric carcinoma.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adenocarcinoma / genetics*
  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology
  • Ascitic Fluid / genetics*
  • Ascitic Fluid / pathology
  • Carcinoembryonic Antigen / genetics
  • Computer Systems*
  • Evaluation Studies as Topic
  • Feasibility Studies
  • Humans
  • Outcome Assessment, Health Care*
  • Predictive Value of Tests
  • Reverse Transcriptase Polymerase Chain Reaction*
  • Sensitivity and Specificity
  • Stomach Neoplasms / genetics*
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Survival Analysis


  • Carcinoembryonic Antigen