Scott S A, van der Zanden C, Cai E, McGahan C E, Kwon J S
Dalhousie University, Canada.
Radboud University, Netherlands.
Gynecol Oncol. 2017 May;145(2):262-268. doi: 10.1016/j.ygyno.2017.03.011. Epub 2017 Mar 28.
There is uncertainty surrounding the prognostic value and clinical utility of peritoneal cytology in endometrial cancer. Our primary objective was to determine if positive cytology is associated with disease-free and overall survival in women treated surgically for endometrial cancer, specifically those with low or intermediate risk disease.
This was a retrospective population-based cohort study of British Columbia Cancer Registry patients who underwent surgery with peritoneal washings for endometrioid-type endometrial cancer from 2003 to 2009. Low risk was defined as Stage IA grade 1 or 2, and intermediate risk defined as Stage IA grade 3, or Stage IB grade 1 or 2 tumours. Five-year overall and disease free-survival were assessed using Kaplan-Meier estimation. Potential covariates including peritoneal cytology, grade, depth of myometrial invasion, LVSI, age, and adjuvant therapy were evaluated in a multivariable Cox proportional hazards model.
There were 849 patients, of whom 370 (43.6%) and 298 (35.1%) had low- and intermediate-risk disease, respectively. Overall, forty-nine (5.8%) patients had positive cytology, including 6 and 9 with low- and intermediate-risk respectively (2.2% within low and intermediate risk combined). Positive peritoneal cytology was not significantly associated with disease-free (HR 3.17, 95% CI 0.91-11.03) or overall survival (HR 1.33, 95% CI 0.47-3.76) in low and intermediate risk patients. Only age and extensive LVSI were associated with lower overall survival (HR 1.10, 95% CI 1.08-1.13, and HR 2.39, 95% CI 1.02-5.61, respectively).
Positive peritoneal cytology was not associated with disease-free and overall survival in women with low and intermediate risk endometrial cancer.
子宫内膜癌腹膜细胞学检查的预后价值和临床实用性存在不确定性。我们的主要目的是确定在接受手术治疗的子宫内膜癌女性，特别是那些患有低风险或中风险疾病的女性中，细胞学检查阳性是否与无病生存期和总生存期相关。
这是一项基于人群的回顾性队列研究，研究对象为2003年至2009年在英属哥伦比亚癌症登记处接受子宫内膜样型子宫内膜癌手术并进行腹膜冲洗的患者。低风险定义为IA期1级或2级，中风险定义为IA期3级，或IB期1级或2级肿瘤。使用Kaplan-Meier估计法评估5年总生存期和无病生存期。在多变量Cox比例风险模型中评估包括腹膜细胞学、分级、肌层浸润深度、淋巴血管间隙浸润（LVSI）、年龄和辅助治疗在内的潜在协变量。
共有849例患者，其中370例（43.6%）和298例（35.1%）分别患有低风险和中风险疾病。总体而言，49例（5.8%）患者细胞学检查呈阳性，其中低风险和中风险分别为6例和9例（低风险和中风险合并为2.2%）。在低风险和中风险患者中，腹膜细胞学检查阳性与无病生存期（风险比3.17，95%置信区间0.91 - 11.03）或总生存期（风险比1.33，95%置信区间0.47 - 3.76）无显著相关性。只有年龄和广泛的淋巴血管间隙浸润与较低的总生存期相关（风险比分别为1.10，95%置信区间1.08 - 1.13，以及风险比2.39，95%置信区间1.02 - 5.61）。
在患有低风险和中风险子宫内膜癌的女性中，腹膜细胞学检查阳性与无病生存期和总生存期无关。
