Níveis dos marcadores CEA e CA 19-9 no soro e no lavado peritoneal na avaliação do comprometimento linfonodal do carcinoma gástrico
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Resumo
Introdução: A recidiva peritoneal precoce do carcinoma gástrico operado com intenção curativa constitui grande desafio para seu tratamento e prevenção. Objetivo: Analisar a relação entre os níveis do marcador tumoral CEA e CA 19-9 no sangue e no lavado peritoneal e o comprometimento linfonodal do carcinoma gástrico. Métodos: Foram estudados 46 doentes operados por carcinoma gástrico. Vinte e nove (63%) eram do sexo masculino e 17 (37%) do sexo feminino. Ressecção gástrica curativa foi realizada em 40 (91,3%) e gastrectomia paliativa em 4 (8,7%). A média de idade foi de 63,6 ± 11,7 anos (31 a 91 anos). Após a indução anestésica, o sangue venoso periférico foi coletado de veia do membro superior para a determinação do nível sérico do CEA e CA 19-9. Após o término do procedimento operatório foram derramados 50 mL de solução fisiológica no fundo de saco de Douglas, aspirada alíquota para a determinação do nível no lavado peritoneal do CEA e CA 19-9. Resultados: Na comparação entre os doentes com e sem linfonodos comprometidos pelo carcinoma gástrico, os níveis de CEA sérico e no lavado peritoneal não apresentaram diferença significante (p = 0,62 e p = 0,13, respectivamente). Não houve diferença significativa (p = 0,43) entre os níveis do CA 19-9 sérico e no lavado peritoneal nos enfermos com acometimento linfonodal pelo carcinoma gástrico. Na comparação entre os doentes com e sem linfonodos comprometidos, os níveis de CA 19-9 no lavado peritoneal foram significantemente maiores do que os do sangue periférico (p = 0,03). Conclusões: Nos doentes com carcinoma gástrico, o nível no lavado peritoneal do CA 19-9 pode sinalizar presença de infiltração linfonodal e constituir parâmetro para a indicação de tratamento adjuvante.
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Referências
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