Peritoneal dissemination (PD) is a major type of gastric cancer (GC) recurrence and leads to rapid death. Current approaches cannot precisely determine which patients are at high risk of PD to provide early intervention. In this study, we developed a technology to detect minimal residual cancer cells in peritoneal lavage fluid (PLF) samples with a personalized assay profiling tumor-specific mutations. In a prospective cohort of 104 GC patients, the technology detected all the cases that developed PD with 100% sensitivity and 85% specificity. The minimal residual cancer cells in PLF were associated with a significantly increased risk of PD (HR = 145.13; 95% CI 20.20–18,435.79; p < 0.001), which was the strongest independent predictor over pathologic diagnosis and cytological diagnosis. In pathologically high-risk (pT4) patients, the PLF mutation profiling model exhibited a greater specificity of 91% and a positive predictive value of 88% while retaining a sensitivity of 100%. This approach may help in the postsurgical management of GC patients by detecting PD far before metastatic lesions grow to a significant size detectable by conventional methods such as MRI and CT scanning.

中文翻译：

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腹腔灌洗液中微量残留癌细胞的个性化分析预测胃癌的腹膜播散

腹膜播散 (PD) 是胃癌 (GC) 复发的主要类型，可导致快速死亡。当前的方法无法准确确定哪些患者处于 PD 高风险中以提供早期干预。在这项研究中，我们开发了一种技术，通过分析肿瘤特异性突变的个性化分析来检测腹膜灌洗液 (PLF) 样本中的最小残留癌细胞。在 104 名 GC 患者的前瞻性队列中，该技术以 100% 的灵敏度和 85% 的特异性检测到所有发生 PD 的病例。PLF 中最小残留癌细胞与 PD 风险显着增加相关（HR = 145.13；95% CI 20.20–18,435.79；p < 0.001），这是病理诊断和细胞学诊断中最强的独立预测因子。在病理高危 (pT4) 患者中，PLF 突变分析模型表现出更高的特异性 91% 和 88% 的阳性预测值，同时保持 100% 的敏感性。这种方法可能有助于 GC 患者的术后管理，通过在转移性病变长到可通过常规方法（如 MRI 和 CT 扫描）检测到的显着大小之前检测到 PD。