J Korean Surg Soc.  2013 Apr;84(4):209-215. 10.4174/jkss.2013.84.4.209.

Cancer cells with p53 deletion detected by fluorescent in situ hybridization in peritoneal drainage fluid is correlated with early peritoneal seeding in resectable pancreatic cancer

• Kang MJ
• Han SS
• Jang JY
• Park JW
• Kwon W
• Chang YR
• Kim SW

• KMID: 2212465
• DOI: http://doi.org/10.4174/jkss.2013.84.4.209

Abstract

PURPOSE
Free 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.
METHODS
Twenty-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.
RESULTS
Among 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.
CONCLUSION
FISH 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.

Keyword

Pancreatic neoplsms; Peritoneal fluid; Fluorescent in situ hybridization; p53 gene

MeSH Terms

Ascitic Fluid
Drainage
Follow-Up Studies
Genes, p53
Humans
In Situ Hybridization, Fluorescence
Neoplasm Metastasis
Pancreatic Neoplasms
Recurrence
Risk Factors
Seeds

Figure

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  Fig. 1 Fluorescent in situ hybridization analysis of p53 using single color probe. A normal cell is shown with two orange signals. Heterozygous deletion of p53 is shown with one orange signal in a pancreatic cancer cell detected in peritoneal fluid.

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  Fig. 2 Peritoneal metastasis-free survival according to p53 deletion detected by fluorescent in situ hybridization in peritoneal drainage fluid. Median survival was shorter in patients with p53 deletion than those without (11.1 months vs. 30.3 months, P = 0.030).

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