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Purpose: Peritoneal carcinomatosis in gastric cancer (GC) patients results in extremelypoor prognosis. Malignant ascites samples are the most appropriate biological material touse to evaluate biomarkers for peritoneal carcinomatosis. This study identified exosomalMicroRNAs (miRNAs) differently expressed between benign liver cirrhosis-associated ascites(LC-ascites) and malignant gastric cancer-associated ascites (GC-ascites), and validated theirrole as diagnostic biomarkers for GC-ascites. Materials and Methods: Total RNA was extracted from exosomes isolated from 165 ascitessamples (73 LC-ascites and 92 GC-ascites). Initially, microarrays were used to screen theexpression levels of 2,006 miRNAs in the discovery cohort (n=22). Subsequently, quantitativereverse transcriptase-polymerase chain reaction (qRT-PCR) analyses were performed tovalidate the expression levels of selected exosomal miRNAs in the training (n=70) andvalidation (n=73) cohorts. Furthermore, carcinoembryonic antigen (CEA) levels weredetermined in ascites samples. Results: The miR-574-3p, miR-181b-5p, miR-4481, and miR-181d were significantlydownregulated in the GC-ascites samples compared to the LC-ascites samples, and miR-181b-5p showed the best diagnostic performance for GC-ascites (area under the curve[AUC]=0.798 and 0.846 for the training and validation cohorts, respectively). The diagnosticperformance of CEA for GC-ascites was improved by the combined analysis of miR-181b-5pand CEA (AUC=0.981 and 0.946 for the training and validation cohorts, respectively). Conclusions: We identified exosomal miRNAs capable of distinguishing between non-malignant and GC-ascites, showing that the combined use of miR-181b-5p and CEA couldimprove diagnosis.

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