Wethington Stephanie L, Barrena Medel Nicanor I, Wright Jason D, Herzog Thomas J
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, USA.
Gynecol Oncol. 2009 Oct;115(1):18-25. doi: 10.1016/j.ygyno.2009.06.019. Epub 2009 Jul 26.
Review the literature on positive peritoneal cytology in endometrioid endometrial adenocarcinoma, its prognostic value, proposed treatment strategies, and future avenues of investigation.
PubMed search of articles pertaining to stage IIIA endometrioid endometrial adenocarcinoma identified over 50 articles that were reviewed. Low-risk stage IIIA1 was defined as those with grade 1 or 2 disease, no evidence of cervical involvement, myometrial invasion less than 50% and no lymph vascular space invasion (LVSI). Analysis of available data was completed with weighted averages, Student's-t-test and Chi square statistical analyses.
Incidence of positive washings is approximately 11%. In low-risk stage IIIA1 endometrial carcinoma patients, the rate of recurrence is 4.1%. In contrast, in high-risk stage IIIA1 endometrial carcinoma patients the rate of recurrence is 32%, a statistically significant difference (p<0.001). Positive peritoneal cytology is associated with an increased incidence of extrauterine disease but is not consistently linked to other high-risk factors such as positive lymph node status, extent of myometrial invasion or LVSI.
To date there is no definitive consensus on the prognostic significance of positive peritoneal cytology alone. However, even in the low-risk cohort with stage IIIA1 some patients will recur. Adjuvant therapy for low-risk stage IIIA diseased may or may not be of benefit. High-risk disease should be treated with chemotherapy, radiation or a combination thereof. A prospective, multicenter trial of comprehensively surgically staged patients with stage IIIA endometrial cancer is indicated in order to clearly define prognosis and treatment for these patients.
回顾关于子宫内膜样腺癌中阳性腹腔细胞学检查的文献，包括其预后价值、提出的治疗策略以及未来的研究方向。
通过PubMed搜索与ⅢA期子宫内膜样腺癌相关的文章，共检索到50多篇文章并进行了综述。低风险ⅢA1期定义为组织学1级或2级、无宫颈受累证据、肌层浸润小于50%且无淋巴血管间隙浸润（LVSI）的患者。采用加权平均值、Student's - t检验和卡方统计分析对现有数据进行分析。
腹腔冲洗液阳性的发生率约为11%。在低风险ⅢA1期子宫内膜癌患者中，复发率为4.1%。相比之下，高风险ⅢA1期子宫内膜癌患者的复发率为32%，差异具有统计学意义（p<0.001）。阳性腹腔细胞学检查与子宫外疾病发生率增加相关，但与其他高风险因素（如阳性淋巴结状态、肌层浸润程度或LVSI）并无始终一致的关联。
迄今为止，对于单纯阳性腹腔细胞学检查的预后意义尚无明确共识。然而，即使在低风险的ⅢA1期队列中，仍有部分患者会复发。低风险ⅢA期疾病的辅助治疗可能有益，也可能无益。高风险疾病应采用化疗、放疗或两者联合治疗。有必要开展一项针对ⅢA期子宫内膜癌全面手术分期患者的前瞻性多中心试验，以明确这些患者的预后和治疗方案。
