Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany.
Gynecol Oncol. 2021 Jun;161(3):710-719. doi: 10.1016/j.ygyno.2021.03.012. Epub 2021 Mar 13.
The collection of a peritoneal cytologic sample at the time of surgery for endometrial cancer has traditionally been an important part of surgical staging. In 2009, the International Federation of Gynecology and Obstetrics revised the cancer staging schema for endometrial cancer and removed peritoneal cytology from the staging criteria. The current National Comprehensive Cancer Network guidelines and the International Federation of Gynecology and Obstetrics organization, however, recommend evaluation of peritoneal cytology at the time of hysterectomy. This study examined population-based trends, characteristics, and outcomes of peritoneal cytologic sampling for endometrial cancer surgery following the 2009 staging revision in the United States.
This is a retrospective observational study querying the Surveillance, Epidemiology, and End Results Program to examine women with stage I-III endometrial cancer who underwent hysterectomy from 2010 to 2017. Trends, characteristics, and survival associated with peritoneal cytologic evaluation at the time of hysterectomy were assessed in multivariable analysis and with propensity score weighting.
Among 62,809 women who underwent hysterectomy, 43,873 (69.9%) had peritoneal cytologic evaluation at surgery and 18,936 (30.1%) did not. Utilization of peritoneal cytologic evaluation decreased from 75.5% to 64.9% during the study period (P < 0.001). In multivariable analysis, more recent year of surgery was independently associated with a decreased likelihood of performance of peritoneal cytology (adjusted-odds ratio of peritoneal cytology evaluation in 2017 versus 2010 0.56, 95% confidence interval [CI] 0.52-0.60). Peritoneal cytologic evaluation at the time of hysterectomy was associated with improved all-cause mortality (hazard ratio in the whole cohort 0.94, 95%CI 0.89-0.99; and hazard ratio in endometrioid histology 0.90, 95%CI 0.84-0.97).
Performance of peritoneal cytologic sampling has gradually decreased following the 2009 staging revision in the United States. Our study suggests that peritoneal cytology evaluation at hysterectomy may be associated with improved survival in certain tumor groups.
传统上，在子宫内膜癌手术时收集腹膜细胞学样本是手术分期的重要组成部分。2009 年，国际妇产科联合会修订了子宫内膜癌的癌症分期方案，并将腹膜细胞学从分期标准中删除。然而，目前的国家综合癌症网络指南和国际妇产科联合会组织建议在子宫切除时评估腹膜细胞学。本研究在美国 2009 年分期修订后，检查了基于人群的趋势、特征和腹膜细胞学取样在子宫内膜癌手术中的结果。
这是一项回顾性观察性研究，通过监测、流行病学和最终结果计划查询了 2010 年至 2017 年间接受子宫切除术的 I-III 期子宫内膜癌女性。在多变量分析和倾向评分加权中评估了在子宫切除时进行腹膜细胞学评估的趋势、特征和生存情况。
在接受子宫切除术的 62809 名女性中，有 43873 名（69.9%）在手术时进行了腹膜细胞学检查，18936 名（30.1%）未进行。在研究期间，腹膜细胞学检查的使用率从 75.5%下降到 64.9%（P < 0.001）。在多变量分析中，手术年份较近与腹膜细胞学检查的可能性降低独立相关（2017 年与 2010 年相比，腹膜细胞学检查的调整优势比为 0.56，95%置信区间[CI] 0.52-0.60）。在子宫切除时进行腹膜细胞学检查与全因死亡率降低相关（整个队列的风险比为 0.94，95%CI 0.89-0.99；子宫内膜样组织学的风险比为 0.90，95%CI 0.84-0.97）。
在美国 2009 年分期修订后，腹膜细胞学取样的实施逐渐减少。我们的研究表明，在某些肿瘤组中，子宫切除时进行腹膜细胞学检查可能与生存率提高有关。
