Ribeiro Carolina Machado, Brito Luiz Gustavo Oliveira, Benetti-Pinto Cristina Laguna, Teixeira Júlio César, Yela Daniela Angerame
Division of Minimally Invasive Gynecologic Surgery (Drs. Ribeiro, Brito, Benetti-Pinto, and Yela), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
Divison of Gynecologic Oncology (Dr. Teixeira), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
J Minim Invasive Gynecol. 2021 Aug;28(8):1536-1543. doi: 10.1016/j.jmig.2021.01.002. Epub 2021 Jan 11.
Although hysteroscopy (HSC) can be used for assessing the uterine cavity in women with suspected endometrial cancer (EC), it remains controversial as a procedure because it can potentially enhance the metastatic spread of cancer cells. Moreover, it is important to assess this hypothesis for type II EC, a more aggressive phenotype that usually presents with endometrial atrophy and has worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology result in women with type II EC who underwent HSC as a diagnostic tool and to determine the factors associated with patient relapse/survival.
Retrospective cohort analysis (2002-2017).
Tertiary, academic hospital.
One hundred twenty-seven women with type II EC.
Diagnostic HSC (HSC) (n = 43) or dilation/curettage (D&C) (n = 84).
Primary end point was the frequency of positive peritoneal cytology result. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio (HR) and 95% confidence intervals (CIs) were calculated to assess the factors related with the disease-free survival (DFS) and the disease-specific survival (DSS). Advanced cancer stage and greater vascular invasion appeared more frequently in the D&C group (p = .008 and p = .04, respectively). Positive peritoneal cytology result was present in 2 of 43 (4.6%) women following HSC and in 9 of 84 (10.7%) following D&C (p = .22). DFS and DSS curves did not statistically differ between the groups. Multivariate analysis for DFS revealed that advanced cancer stage (III and IV) (HR = 4.67; 95% CI, 2.34-9.34; p <.001) and advanced age (HR = 1.08; 95% CI, 1.04-1.13]; p <.001) were the factors associated with relapse. For DSS, advanced age (HR = 1.08; 95% CI, 1.05-1.12; p <.001), cancer stage III/IV (HR = 3.95; 95% CI, 2.18-7.15; p <.001), and vascular invasion (HR = 2.47; 95% CI, 1.34-4.54; p = .004) increased the risk of mortality.
Diagnostic HSC did not increase the rate of positive peritoneal cytology result at the time of surgical staging in this cohort of women with type II EC and is probably as safe as D&C.
尽管宫腔镜检查（HSC）可用于评估疑似子宫内膜癌（EC）女性的子宫腔，但作为一种检查方法仍存在争议，因为它可能会促进癌细胞的转移扩散。此外，评估这一假说对于II型EC很重要，II型EC是一种侵袭性更强的表型，通常表现为子宫内膜萎缩且预后较差。因此，我们旨在评估将HSC作为诊断工具的II型EC女性中腹膜细胞学检查结果阳性的发生率，并确定与患者复发/生存相关的因素。
回顾性队列分析（2002 - 2017年）。
三级学术医院。
127例II型EC女性。
诊断性HSC（n = 43）或刮宫术（D&C）（n = 84）。
主要终点是腹膜细胞学检查结果阳性的频率。使用Kaplan-Meier方法绘制生存曲线，并使用对数秩检验进行比较。计算具有风险比（HR）和95%置信区间（CIs）的Cox回归分析，以评估与无病生存期（DFS）和疾病特异性生存期（DSS）相关的因素。D&C组中晚期癌症分期和更高的血管侵犯更为常见（分别为p = 0.008和p = 0.04）。HSC术后43例女性中有2例（4.6%）腹膜细胞学检查结果阳性，D&C术后84例中有9例（10.7%）阳性（p = 0.22）。两组间DFS和DSS曲线无统计学差异。DFS的多因素分析显示，晚期癌症分期（III期和IV期）（HR = 4.67；95% CI，2.34 - 9.34；p < 0.001）和高龄（HR = 1.08；95% CI，1.04 - 1.13；p < 0.001）是与复发相关的因素。对于DSS而言，高龄（HR = 1.08；95% CI，1.05 - 1.12；p < 0.001）、癌症III/IV期（HR = 3.95；95% CI，2.18 - 7.15；p < 0.001）和血管侵犯（HR = 2.47；95% CI，1.34 - 4.54；p = 0.004）增加了死亡风险。
在这组II型EC女性中，诊断性HSC在手术分期时并未增加腹膜细胞学检查结果阳性的发生率，可能与刮宫术一样安全。
