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Introduction: The dissemination of free peritoneal tumor cells (FPTC) in the process of metastasis is understood as an event, which occurs by continous tumor progression of an serosa invading, invasive carcinoma. We examined, if free peritoneal tumor cells were detectable in patients with gastric carcinoma UICC stage I and if these cells have prognostic impact. Methods: Peritoneal lavage was performed in 164 patients with gastric carcinoma stage I during 1987 and 2001. Immunocytochemical staining with the antibody directed against Ber-Ep4 after centrifugation of the peritoneal fluid was used for the evaluation of free peritoneal tumour cells. The median follow-up time was 70 months. Results: Fourteen patients (9%) had immunocytochemical detected, free peritoneal tumor cells (FPTC) in the examined peritoneal lavage. Seven patients (7%) with early stage gastric carcinoma (pT1) had FPTC. The 10-year overall survival of patients with FPTC was 89% ± 3% and significantly worse than the survival of patients without detection of FPTC (58% ± 17%) (p < 0,01). Patients with gastric carcinoma at stage I or stage II had in combination with the detcetion of FPTC almost identical 10 year overall survival rates of 58% and 59%, respectively. Multivariate analysis identified the lymph node status (pN), the depth of tumor infitration (pT) and the detection of free peritoneal tumor cells as independent prognostic factors with a relative risk of 10.5 (confidence intervall 79.0–1.4), 8,5 (CI 37.7–1.9) und 4.6 (CI 15.4–1.4). Conclusion: Free peritoneal tumor cells are detectable in gastric carcinoma stage UICC I and have prognostic impact. There is evidence that tumour infiltration of blood and lymph vessels located in the submucosa layer lead to peritoneal tumour spread. |
