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Updated: May 7, 2026
Quantitation of Intra-peritoneal Ovarian Cancer Metastasis
Published on: July 18, 2016
Flow cytometric quantification of intraperitoneal free tumor cells in patients with peritoneal metastasis
Joji Kitayama1, Shigenobu Emoto, Hironori Yamaguchi
1Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
Background:
Peritoneal metastasis (PM) is the most life-threatening type of metastasis in abdominal malignancy. To improve the diagnostic accuracy of cytologic detection (CY) of free tumor cells (FTC) in the peritoneal cavity, we tried to quantify the FTC to leukocyte ratio using flow cytometry in patients with peritoneal metastasis.
Methods:
Cells were recovered from ascites or peritoneal lavages from 106 patients who underwent abdominal surgery and additional 89 samples which were obtained from peritoneal catheter or access port in patients with PM (+) gastric cancer. The cells were immunostained with monoclonal antibodies to CD45 and to CD326 (EpCAM). Using flow cytometry, CD326 (+) and CD45 (+) cells were classified as either tumor cells (T) or leukocytes (L) and the T/L ratio (TLR) was calculated.
Results:
In 106 samples obtained by laparotomy, Median (M) of the TLR of PM (+) patients was 1.39% (0-807.87%) which was significantly higher than PM (-) patients (M=0%, 0-2.14%, P < 0.001). In PM (+) patients, 86 CY (+) samples showed higher TLR than 61 CY (-) samples (M=2.81%, 0.02-1868.44% vs. M=0%, 0-3.45%, p<0.0001). In all of the 24 patients who were monitored for TLR before and after intraperitoneal (IP) chemotherapy, the TLR was reduced which was more dramatic than the results of the change in cytology.
Conclusions:
TLR measured with FACS is an excellent reflection of the tumor spread in the peritoneal cavity and could be a reliable diagnostic biomarker to determine the severity of PM as well as effectiveness of IP chemotherapy.
Insights
The tumor cell to leukocyte ratio (TLR) quantified by flow cytometry is a reliable biomarker for detecting peritoneal metastasis (PM) and assessing treatment effectiveness in cancer patients.
Area of Science:
- Oncology
- Surgical Pathology
- Diagnostic Cytology
Background:
- Peritoneal metastasis (PM) significantly impacts patient outcomes in abdominal malignancies.
- Current cytologic detection (CY) methods for free tumor cells (FTC) in peritoneal fluid have limitations.
- Quantifying FTC to leukocyte ratio (TLR) may enhance diagnostic accuracy.
Purpose of the Study:
- To evaluate the utility of flow cytometry for quantifying the tumor cell to leukocyte ratio (TLR) in peritoneal metastasis (PM).
- To assess TLR as a diagnostic biomarker for PM and its correlation with cytologic detection (CY).
- To determine the effectiveness of intraperitoneal (IP) chemotherapy by monitoring TLR changes.
Main Methods:
- Collected ascites/lavage samples from 106 patients undergoing abdominal surgery and 89 from PM (+) gastric cancer patients.
- Immunostained cells for CD45 (leukocytes) and CD326 (tumor cells).
- Utilized flow cytometry to calculate the tumor cell (T) to leukocyte (L) ratio (TLR).
Main Results:
- TLR was significantly higher in PM (+) patients compared to PM (-) patients (Median 1.39% vs. 0%, P < 0.001).
- Higher TLR observed in CY (+) samples than CY (-) samples within PM (+) patients (Median 2.81% vs. 0%, P < 0.0001).
- TLR decreased significantly after intraperitoneal (IP) chemotherapy, outperforming cytology in reflecting treatment response.
Conclusions:
- Flow cytometry-based TLR measurement is a sensitive and specific biomarker for peritoneal metastasis (PM).
- TLR effectively reflects the extent of tumor spread in the peritoneal cavity.
- TLR serves as a reliable indicator for assessing the efficacy of IP chemotherapy.
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