Immunocytochemically detected free peritoneal tumour cells (FPTC) are a strong prognostic factor in gastric carcinoma

We prospectively investigated the prognostic significance of free peritonea l tumour cells (FPTC) in a series of 118 patients with completely resected gastric carcinoma. Immunocytochemistry with the monoclonal antibody Ber-Ep4 was performed on cytospins from intraoperative peritoneal lavage specimens . Twenty-three patients (20%) had FPTC which was significantly correlated w ith pT and pN categories, stage, tumour size, lymphatic invasion, Lauren an d WHO classifications and perigastric adipose tissue metastases. The median survival time for all FPTC positive compared with negative patients was si gnificantly shorter (11 compared with > 72 months), with estimated 5-year s urvival rates of 8% vs. 60%. None of the patients with FPTC had an early ga stric cancer. In advanced tumour subgroups without and with serosal invasio n (n = 59 and 35), there were 19% and 34% with FPTC. Multivariate survival analysis showed nodal status, FPTC, mesenteric lymphangiosis, and lymph nod e metastasis to the compartment ill to be independent prognostic factors wi th relative risks of 6.6, 4.5, 2.9 and 2.2 respectively. Recurrent disease occurred in 91% of FPTC-positive and in 38% of FPTC-negative patients. FPTC had a positive predictive Value of 91% and a specificity of 97% for tumour recurrence. FPTC is a strong negative, independent prognostic indicator fo r survival in gastric carcinoma.