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.
Ann Surg Oncol. 2021 Nov;28(12):7591-7603. doi: 10.1245/s10434-021-09900-4. Epub 2021 Apr 1.
The aim of this study was to examine the survival effect of adjuvant therapy in stage II-III endometrial cancer based on peritoneal cytology results.
The National Cancer Institute's Surveillance, Epidemiology, and End Results Program was retrospectively queried to examine 7467 women with stage II-III endometrial cancer who underwent hysterectomy, and with available peritoneal cytology results, from 2010 to 2016. A Cox proportional hazard regression model was fitted to assess the association between adjuvant therapy and all-cause mortality stratified by peritoneal cytology results.
Malignant peritoneal cytology was reported in 1662 (22.3%) women and was associated with non-endometrioid histology, higher tumor stage, and nodal metastasis (p < 0.05). In a propensity score-weighted model, malignant peritoneal cytology was associated with increased all-cause mortality compared with negative peritoneal cytology (hazard ratio 1.35, 95% confidence interval 1.23-1.48). Adjuvant therapy types varied based on histology and peritoneal cytology results. In non-endometrioid histology, the combination of chemotherapy and whole pelvic radiotherapy (WPRT) was associated with improved overall survival compared with chemotherapy or WPRT alone irrespective of the peritoneal cytology results (p < 0.05). The combination of chemotherapy and WPRT was also associated with improved overall survival in women with endometrioid histology and malignant peritoneal cytology (p = 0.026). Women with endometrioid histology and negative peritoneal cytology represented the most common subpopulation (46.5%), and overall survival was similar regardless of which of the three adjuvant therapy modalities was used (p = 0.319).
Malignant peritoneal cytology is prevalent and prognostic in stage II-III endometrial cancer. This study found that the surgeon's choice and benefit of adjuvant therapy for women with stage II-III endometrial cancer differed depending on the status of peritoneal cytology.
本研究旨在基于腹腔细胞学检查结果，探讨 II 期-III 期子宫内膜癌辅助治疗的生存效果。
回顾性检索美国国家癌症研究所的监测、流行病学和最终结果计划，纳入 2010 年至 2016 年间接受子宫切除术且有腹腔细胞学检查结果的 7467 名 II 期-III 期子宫内膜癌患者。采用 Cox 比例风险回归模型，按腹腔细胞学检查结果分层，评估辅助治疗与全因死亡率之间的关联。
1662 名（22.3%）患者的腹腔细胞学检查结果为恶性，与非子宫内膜样组织学、更高的肿瘤分期和淋巴结转移有关（p<0.05）。在倾向评分加权模型中，与阴性腹腔细胞学检查相比，恶性腹腔细胞学检查与全因死亡率增加相关（风险比 1.35，95%置信区间 1.23-1.48）。辅助治疗类型根据组织学和腹腔细胞学检查结果而有所不同。在非子宫内膜样组织学中，与单独化疗或盆腔放疗（WPRT）相比，化疗联合 WPRT 无论腹腔细胞学检查结果如何均与总生存改善相关（p<0.05）。化疗联合 WPRT 也与恶性腹腔细胞学检查的子宫内膜样组织学患者的总生存改善相关（p=0.026）。非子宫内膜样组织学且阴性腹腔细胞学检查的患者占最常见的亚组（46.5%），无论使用三种辅助治疗方式中的哪一种，总生存情况相似（p=0.319）。
恶性腹腔细胞学检查在 II 期-III 期子宫内膜癌中普遍存在且具有预后意义。本研究发现，对于 II 期-III 期子宫内膜癌患者，手术医生选择辅助治疗的方式和获益取决于腹腔细胞学检查的状态。
