Relationship between peritoneal collagen type IV concentrations and the presence of disseminated metastases in gastric cancer

D. Korenaga, S. Funahashi, K. Yano, S. Maekawa, T. Ikeda and K. Sugimachi
Department of Surgery, Fukuoka (Japan) City Hospital.

OBJECTIVE: To predict disseminated microscopic foci or occult micrometastases in the peritoneal cavity in patients with gastric cancer. DESIGN: Randomly selected patients with gastric cancer had peritoneal washings performed at the beginning of laparotomy. PATIENTS: Thirty-nine patients with gastric carcinoma and 10 patients with other benign disease as a control group. SETTING: Inpatients in a surgical department. INTERVENTIONS: The concentration of collagen type IV in the irrigated peritoneal fluid was measured radioimmunologically. Intraoperative peritoneal cytologic examination and measurements of carcinoembryonic antigen (CEA) levels were also performed. MAIN OUTCOME MEASUREMENTS: Results of the quantitative analyses of the collagen type IV concentrations as related to the clinicopathological characteristics and comparison of these results with regard to those of the peritoneal cytologic examination and CEA and collagen type IV levels. RESULTS: There were eight patients with elevated collagen type IV concentrations. They had carcinomas with serosal invasion (pT3 and pT4) and metastatic spread (pN2, M1). Patients with clinically evident peritoneal disseminated metastases had significantly higher collagen type IV concentrations compared with those without metastases. The collagen type IV levels were more sensitive than peritoneal cytologic examination or CEA values in detecting disseminated metastases. There was an early peritoneal recurrence in the form of ovarian metastases in one patient with negative cytologic results and an elevated collagen type IV level. Linear regression analysis showed a statistically significant correlation between the collagen type IV and CEA levels. CONCLUSION: Quantitative detection of abnormal collagen type IV levels may be useful for predicting the presence of disseminated metastases in patients with gastric cancer.