Annals of surgical oncology · 2025
Peritoneal Lavage Cytology Predicts Peritoneal Metastasis and is Associated with Poor Prognosis in Patients with Stage II-III Colorectal Cancer.
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Kong Dewei, Li Yingjie, Yin Shenyi, Tan Yunfei, Qu Boyang, Huang Lei, Xi Jianzhong Jeff, Wu Aiwen
Аннотация
BACKGROUND: Peritoneal lavage cytology (PLC) is used to detect peritoneal micrometastases in gastrointestinal malignancies, but its prognostic value in colorectal cancer (CRC) remains controversial, particularly in stage II-III. We aimed to evaluate the prognostic significance of PLC in predicting postoperative outcomes and peritoneal metastasis risk among patients with stage II-III CRC, thereby facilitating individualized treatment strategies.
PATIENTS AND METHODS: A retrospective analysis was performed on 375 patients with stage II-III CRC who underwent curative resection with standardized intraoperative PLC between January 2017 and August 2018. Survival outcomes, including 5-year disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), were assessed using Kaplan-Meier analysis and Cox regression models. A prognostic nomogram incorporating PLC status along with other clinicopathological factors was developed and validated using area under the curve (AUC), C-index, and calibration curves. A competing risk analysis was performed to further elucidate the association between PLC positivity and specific metastasis patterns.
RESULTS: PLC positivity, observed in 9.9% of patients, predicted reduced 5-year DFS and CSS, particularly in stage II patients, but not in stage III patients. Multivariate analysis identified PLC positivity as an independent prognostic factor for DFS (HR = 2.35, 95% CI 1.11-4.95, P = 0.025), along with preoperative CA199, tumor location, lymphovascular invasion, and N stage. The prognostic model demonstrated excellent discrimination (C-index = 0.796) and calibration. In addition, PLC-positive patients exhibited a significantly higher risk of peritoneal metastasis.
CONCLUSIONS: PLC is a valuable prognostic tool for the early detection of micrometastatic risk and peritoneal dissemination in stage II-III CRC, particularly in stage II disease.
PATIENTS AND METHODS: A retrospective analysis was performed on 375 patients with stage II-III CRC who underwent curative resection with standardized intraoperative PLC between January 2017 and August 2018. Survival outcomes, including 5-year disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), were assessed using Kaplan-Meier analysis and Cox regression models. A prognostic nomogram incorporating PLC status along with other clinicopathological factors was developed and validated using area under the curve (AUC), C-index, and calibration curves. A competing risk analysis was performed to further elucidate the association between PLC positivity and specific metastasis patterns.
RESULTS: PLC positivity, observed in 9.9% of patients, predicted reduced 5-year DFS and CSS, particularly in stage II patients, but not in stage III patients. Multivariate analysis identified PLC positivity as an independent prognostic factor for DFS (HR = 2.35, 95% CI 1.11-4.95, P = 0.025), along with preoperative CA199, tumor location, lymphovascular invasion, and N stage. The prognostic model demonstrated excellent discrimination (C-index = 0.796) and calibration. In addition, PLC-positive patients exhibited a significantly higher risk of peritoneal metastasis.
CONCLUSIONS: PLC is a valuable prognostic tool for the early detection of micrometastatic risk and peritoneal dissemination in stage II-III CRC, particularly in stage II disease.