子宫内膜癌中恶性腹膜细胞学预后意义的前瞻性评估：一项NRG肿瘤学/妇科肿瘤学组关于GOG-210方案的研究
Prospective assessment of prognostic significance of malignant peritoneal cytology in endometrial cancer: An NRG Oncology / Gynecologic Oncology Group study on GOG-210 protocol.
作者信息
Matsuo Koji, Enserro Danielle M, Wright Jason D, Roman Lynda D, Powell Matthew A, Miller David S, Nagel Christa I, Thaker Premal H, Mannel Robert S, Stuckey Ashley R, Guntupalli Saketh R, Sukumvanich Paniti, Geller Melissa A, Vargas Roberto, Konecny Gottfried E, Warshal David P, Tewari Krishnansu S, Spirtos Nick M, Pothuri Bhavana, Creasman William T, Mutch David G
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles General Medical Center, Los Angeles, CA, USA.
NRG Oncology Statistics and Data Management Center, Clinical Trials Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
出版信息
Gynecol Oncol. 2025 Sep 3;201:184-194. doi: 10.1016/j.ygyno.2025.08.029.
OBJECTIVE
To examine the association between malignant peritoneal cytology and survival outcomes in endometrial cancer.
METHODS
This was an ancillary analysis of prospectively collected surgical-pathological data in the NRG Oncology / Gynecologic Oncology Group study on GOG-210 protocol. The study population included 2383 patients with stage I-III endometrial cancer from 2003 to 2011. Exposure was peritoneal cytology status: malignant peritoneal cytology (n = 215) or negative peritoneal cytology (n = 2168). Main outcome measures were recurrence-free survival and overall survival. Propensity score inverse probability treatment weighting was performed to balance the baseline clinico-pathological characteristics, followed by adjustment for adjuvant therapy.
RESULTS
Malignant peritoneal cytology was associated with a 32% increased risk of recurrence (5-year rates, 72% versus 77%, hazard ratio 1.32, 95% confidence interval 1.03 to 1.69, P = 0.028) and 37% increased risk of all-cause mortality (78% versus 83%, hazard ratio 1.37, 95% confidence interval 1.06 to 1.78, P = 0.018) compared to negative peritoneal cytology. When controlling for adjuvant therapy, the association between malignant peritoneal cytology and survival was attenuated for both recurrence-free survival (adjusted-hazard ratio 1.16, 95% confidence interval 0.90 to 1.50, P = 0.24) and overall survival (adjusted-hazard ratio 1.22, 95% confidence interval 0.93 to 1.60, P = 0.16) without statistical significance. Peritoneal cytology status and adjuvant therapy type had a possible interaction on overall survival, and malignant peritoneal cytology was associated with decreased overall survival when radiotherapy was received as adjuvant therapy but not when chemotherapy was utilized (P-interaction = 0.059).
CONCLUSION
The results of this prospective assessment suggest that malignant peritoneal cytology is a prognostic factor, if any, associated with a modest decrease in survival for endometrial cancer.
目的
探讨恶性腹腔细胞学检查与子宫内膜癌生存结局之间的关联。
方法
这是一项对NRG肿瘤学/妇科肿瘤学组关于GOG-210方案的前瞻性收集的手术病理数据进行的辅助分析。研究人群包括2003年至2011年期间的2383例I-III期子宫内膜癌患者。暴露因素为腹腔细胞学检查状态：恶性腹腔细胞学检查（n = 215）或阴性腹腔细胞学检查（n = 2168）。主要结局指标为无复发生存期和总生存期。采用倾向评分逆概率治疗加权法平衡基线临床病理特征，随后对辅助治疗进行调整。
结果
与阴性腹腔细胞学检查相比，恶性腹腔细胞学检查与复发风险增加32%相关（5年复发率，72%对77%，风险比1.32，95%置信区间1.03至1.69，P = 0.028），与全因死亡率风险增加37%相关（78%对83%，风险比1.37，95%置信区间1.06至1.78，P = 0.018）。在控制辅助治疗后，恶性腹腔细胞学检查与生存之间的关联在无复发生存期（调整后风险比1.16，95%置信区间0.90至1.50，P = 0.24）和总生存期（调整后风险比1.22，95%置信区间0.93至1.60，P = 0.16）方面均减弱，无统计学意义。腹腔细胞学检查状态和辅助治疗类型在总生存期方面可能存在相互作用，当接受放疗作为辅助治疗时，恶性腹腔细胞学检查与总生存期降低相关，但当使用化疗时则不然（交互作用P = 0.059）。
结论
这项前瞻性评估的结果表明，恶性腹腔细胞学检查是一个预后因素，如果有的话，与子宫内膜癌生存率适度降低相关。
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