Publication

Is detection of intraperitoneal exfoliated tumor cells after surgical resection of rectal cancer a prognostic factor of survival?

Résumé

Background: The prognostic significance of free cancer cells detected in peritoneal fluid at the time of rectal surgery remains unclear. A substantial number of patients will develop metastatic disease even with successful local treatment. This prospective non-randomized study investigated the prognostic value of intraperitoneal free cancer cells harvested in peritoneal lavage after surgery for rectal cancer. Mutational hotspots in mitochondrial DNA were examined as potential molecular signatures to detect circulating intraperitoneal free cancer cells when present in primary tumor and in lavage. Methods: Point mutations in mitochondrial DNA amplifications were determined in primary tumors and corresponding exfoliated intraperitoneal free cancer cells in lavage from 191 patients with locally advanced rectal cancer scheduled for radical treatment. Mitochondrial DNA target sequences were amplified by polymerase chain reaction and base substitutions were detected by denaturant, cycling temperature capillary electrophoresis. Detection of intraperitoneal free cancer cells was correlated to survival. Results: Of 191patients analyzed, 138 (72%) were identified with somatic mitochondrial point mutations in rectal cancer tumors. From this fraction, 45 patients (33%) had positive lavage fluid with corresponding somatic mtDNA point mutations in lavage representing circulating intraperitoneal free cancer cells. There was no significant survival difference between patients identified with or without somatic mitochondrial DNA point mutations in the corresponding lavage. Conclusion: Somatic mitochondrial DNA point mutations identified in primary rectal tumors enable detection of circulating intraperitoneal free cancer cells in lavage fluid. Intraperitoneal free cancer cells harvested from lavage immediately after surgery for rectal cancer does not represent an independent prognostic factor on survival.

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Concepts associés (47)
Cancer colorectal
Le cancer colorectal (ou colo-rectal) est une tumeur maligne de la muqueuse du côlon ou du rectum. Il peut toucher tous les segments anatomiques du gros intestin comme le caecum, le côlon ascendant, le côlon transverse, le côlon descendant, le côlon sigmoïde et le rectum mais ne concerne pas le cancer du canal anal qui est une entité distincte. Le type histologique est un adénocarcinome lieberkühnien dans la majorité des cas. Les symptômes de la maladie dépendent de l'emplacement de la tumeur et de son stade.
Primary tumor
A primary tumor is a tumor growing at the anatomical site where tumor progression began and proceeded to yield a cancerous mass. Most solid cancers develop at their primary site but may then go on to metastasize or spread to other parts of the body. These further tumors are secondary tumors. Most cancers continue to be called after their primary site, as in breast cancer or lung cancer for example, even after they have spread to other parts of the body.
Cancer de la vessie
La paroi interne de la vessie est tapissée de cellules transitionnelles qui sont à l'origine de la plupart des cancers de la vessie. L'évolution et la prise en charge dépend beaucoup du caractère invasif de la tumeur. On distingue le cancer superficiel de la vessie du cancer invasif (tumeur infiltrante). Si le cancer superficiel reste de bon pronostic, le cancer invasif de la vessie est beaucoup plus grave et nécessite des traitements agressifs. Il s'agit de l'un des dix plus fréquents cancers avec un peu plus de 500 000 cas annuels de par le monde.
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