A Study of the Factors of Peritoneal Dissemination Based on the Analysis of Clinicopathological Findings and Cancer Cells in Gastric Cancer with Special Reference to Nuclear DNA of Intraperitoneal Free Cancer Cells

Hidehiro Ugaeri

Second Department of Surgery, School of Medicine, Fukuoka University

Gastric cancer recurs mostly as a peritoneal recurrence, but there are few definite guidelines to estimate and prevent it. In this study, the nuclear DNA content of cancer cells was determined by microspectrofluorometry, and DNA ploidy patterns were classified concerning the intraperitoneal free cancer cells (IPFCC) as well as the original lesion of the patients with gastric cancer, and the results were compared with the clinicopathological findings. The patients were subjected in the study were 110 operated on for gastric cancer with intraperitoneal irrigating cytology. Among them, 90 cases showed positive serosal invasion. IPFCC were positive in 42 cases (38.2%). High positive rates were observed in patients with granular serosal invasion of the primary cancer, with the area of serosal invasion more than 20 cm², with poorly differentiated histological type. A high ploidy pattern was demonstrated in 87.5% of the primary lesions and 90.7% of IPFCC, and significantly frequently in comparison with the negative IPFCC cases. The DNA histogram pattern of the biopsied specimen before surgery coincided with that of the primary lesion in 90.5% of the patients. Therefore, in the case of advanced gastric cancer, it was suggested that the probability of IPFCC would be very high in patient with high ploidy in the DNA histogram with positive serosal invasion. Thus, a feasible guide to active local chemotheraphy and massive peritoneal irrigation on at the end of the operation is to determine the nuclear DNA ploidy pattern of the cancer.

Key words
gastric cancer, intraperitoneal irrigating cytology, intraperitoneal free cancer cells, cancer cell nuclear DNA histogram pattern, peritoneal recurrence

Reprint requests
Hidehiro Ugaeri Second Department of Surgery, School of Medicine, Fukuoka University
45-1 7-chome, Nanakuma, Jonan-ku, Fukuoka, 814-01 JAPAN

Accepted
November 20, 1991

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