DuBeshter B, Warshal D P, Angel C, Dvoretsky P M, Lin J Y, Raubertas R F
Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Strong Memorial Hospital, New York.
Obstet Gynecol. 1991 Mar;77(3):458-62.
In patients with endometrial carcinoma, preoperative identification of poor prognostic factors is helpful in planning therapy. Extended surgical staging, including pelvic and periaortic node dissection, is indicated in patients with deep myometrial invasion or high-grade tumor, or when other risk factors for extrauterine spread are present. In this study, cervical cytology was reviewed in 86 patients with endometrial carcinoma, all of whom underwent surgical staging, to correlate the cytologic results with surgical and pathologic findings. Cervical cytology was normal in 20 patients (23%), whereas suspicious or malignant endometrial cells were present in 23 and 43 cases (27 and 50%), respectively. Suspicious or malignant cervical cytology was associated with deeper myometrial invasion (P = .011), higher postoperative tumor grade (P = .006), positive peritoneal washings (P = .012), and more advanced stage by International Federation of Gynecology and Obstetrics criteria (P = .024). When compared with patients with normal cervical cytology, those who had malignant endometrial cells had over twice the risk of deep myometrial invasion (67 versus 30%), twice the risk of grade 2 or 3 tumor (60 versus 30%), and three times the risk of positive peritoneal washings (33 versus 10%). Seventy-four percent of patients with malignant cervical cytology were stage IC or more. In contrast, 70% of patients with normal cervical cytology were stage IA or IB. Patients with endometrial carcinoma who have malignant endometrial cells detected by cervical cytology are at increased risk of having a deeply invasive, high-grade, advanced-stage tumor, and therefore are more likely to require extended surgical staging.
对于子宫内膜癌患者，术前识别不良预后因素有助于制定治疗方案。对于有肌层深部浸润、高级别肿瘤或存在子宫外扩散其他危险因素的患者，建议进行包括盆腔和腹主动脉旁淋巴结清扫的扩大手术分期。在本研究中，对86例均接受手术分期的子宫内膜癌患者的宫颈细胞学检查结果进行回顾，以将细胞学结果与手术及病理结果相关联。20例患者（23%）宫颈细胞学检查正常，而分别有23例（27%）和43例（50%）存在可疑或恶性子宫内膜细胞。可疑或恶性宫颈细胞学检查结果与肌层深部浸润（P = 0.011）、术后肿瘤高级别（P = 0.006）、腹水阳性（P = 0.012）以及根据国际妇产科联盟标准分期更晚（P = 0.024）相关。与宫颈细胞学检查正常的患者相比，存在恶性子宫内膜细胞的患者发生肌层深部浸润的风险高出两倍多（67%对30%）、发生2级或3级肿瘤的风险高出两倍（60%对30%）、腹水阳性的风险高出三倍（33%对10%）。宫颈细胞学检查为恶性的患者中74%为IC期或更晚期。相比之下，宫颈细胞学检查正常的患者中70%为IA期或IB期。宫颈细胞学检查发现存在恶性子宫内膜细胞的子宫内膜癌患者发生深部浸润、高级别、晚期肿瘤的风险增加，因此更有可能需要进行扩大手术分期。
