Amkreutz L C M, Pijnenborg J M A, Joosten D W L, Mertens H J M M, Van Kuijk S M J, Engelen M J A, Bergmans M, Nolting W E, Kruitwagen R F P M
Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Sittard-Geleen and Heerlen, The Netherlands.
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
Cytopathology. 2018 Feb;29(1):63-70. doi: 10.1111/cyt.12511. Epub 2017 Dec 27.
Abnormal cervical cytology in patients with endometrial cancer (EC) has been associated with poor outcome. The aim of this study was to evaluate whether cervical cytology could contribute to an improved preoperative identification of high-grade EC (serous, clear cell, carcinosarcoma, high-grade endometrioid EC) in final histology.
A retrospective cohort study was performed in five hospitals in the Netherlands. A total of 554 patients with EC that underwent primary surgical treatment between 2002 and 2010 were included. Primary outcome was defined as the contribution of abnormal cervical cytology in the preoperative identification of high-grade EC. As secondary outcome, recurrence-free survival (RFS) and disease-specific survival were determined based on preoperative cervical cytology, and compared to the currently established risk factors: myometrial invasion, high-grade and lymph vascular space invasion.
Abnormal cervical cytology was present in 45.1%. For patients with preoperative inconclusive and high-grade histology, the presence of abnormal cervical cytology contributed to an improved identification of high-grade EC in final histology (odds ratio [OR] 6.40 [95% confidence interval {CI}: 1.92-21.26]; OR 2.86 [95% CI: 1.14-7.14]), respectively. Patients with abnormal cervical cytology had a significant worse 5-year median RFS. Abnormal cervical cytology was independently related to RFS (hazard ratio 1.67 [95% CI: 1.04-2.68]) and disease-specific survival (hazard ratio 3.15 [95% CI: 1.74-5.71]).
Abnormal cytology contributes to the preoperative identification of patients with high-grade EC, and is associated with compromised outcome. Future studies are warranted to determine whether cervical cytology could be incorporated into preoperative prediction models for lymph node metastasis.
子宫内膜癌（EC）患者的宫颈细胞学异常与不良预后相关。本研究的目的是评估宫颈细胞学检查是否有助于在最终组织学检查中改善对高级别EC（浆液性、透明细胞、癌肉瘤、高级别子宫内膜样EC）的术前识别。
在荷兰的五家医院进行了一项回顾性队列研究。纳入了2002年至2010年间接受原发性手术治疗的554例EC患者。主要结局定义为异常宫颈细胞学检查在术前识别高级别EC中的作用。作为次要结局，基于术前宫颈细胞学检查确定无复发生存期（RFS）和疾病特异性生存期，并与目前已确定的危险因素进行比较：肌层浸润、高级别和淋巴血管间隙浸润。
45.1%的患者存在异常宫颈细胞学检查结果。对于术前组织学检查结果不明确和高级别的患者，异常宫颈细胞学检查结果有助于在最终组织学检查中更好地识别高级别EC（优势比[OR]分别为6.40[95%置信区间{CI}：1.92 - 21.26]；OR为2.86[95%CI：1.14 - 7.14]）。宫颈细胞学检查异常的患者5年中位RFS明显更差。异常宫颈细胞学检查与RFS（风险比1.67[95%CI：1.04 - 2.68]）和疾病特异性生存期（风险比3.15[95%CI：1.74 - 5.71]）独立相关。
异常细胞学检查有助于术前识别高级别EC患者，且与预后不良相关。有必要进行进一步研究以确定宫颈细胞学检查是否可纳入淋巴结转移的术前预测模型。
