Influence of positive peritoneal cytology on prognostic factors and survival in early-stage endometrial cancer: a systematic review and meta-analysis

Abstract

Objective: The prognostic significance of positive peritoneal cytology in patients with early-stage endometrial cancer (Stage 1 or 2) is controversial and perhaps depends on the presence of other factors. The relationship of other prognostic factors with positive peritoneal cytology remains unclear. This study aimed to investigate the association between positive peritoneal cytology and prognostic factors and the influence of positive peritoneal cytology on survival in patients with early-stage endometrial cancer. Methods: We identified 351 articles on the PubMed, Cochrane and Embase databases using a combination of the following search terms: endometrial cancer, endometrial carcinoma, positive peritoneal cytology and positive peritoneal washing. When filtered for studies comparing positive peritoneal cytology with negative peritoneal cytology in early-stage endometrial cancer, 11 retrospective studies met the selection criteria. Meta-analyses were performed using Review Manager 5.3 software. Results: In patients with surgical stage 1 or 2 early-stage endometrial cancer, the incidence of Grade 3 was higher and 5-year overall survival was worse in patients with positive peritoneal cytology compared with negative peritoneal cytology. However, the incidence of Grade 1 was lower in those with positive peritoneal cytology compared with negative peritoneal cytology. In patients with surgical stage 1 early-stage endometrial cancer, the incidence of myometrial invasion ≥1/2 tended to be higher and 5-year progression-free survival was worse in the positive peritoneal cytology group than the negative peritoneal cytology group. However, the incidence of myometrial invasion <1/2 was lower in the positive peritoneal cytology group than the negative peritoneal cytology group. Conclusion: This study demonstrates that positive peritoneal cytology in patients with early-stage endometrial cancer is significantly associated with other prognostic factors and survival, suggesting its potential as a prognostic factor.

A novel prediction score for predicting the baseline risk of recurrence of stage I–II endometrial carcinoma

“…In the FIGO 2009 staging system, peritoneal cytology is not associated with clinical stage, and positive peritoneal cytology is indeed not considered as an independent prognostic factor in endometrial cancer. However, some reports have shown a relation between positive peritoneal cytology and poor prognosis in patients with early stage endometrial carcinoma [920]. Although MI is considered to be among the most important prognostic factors for endometrial cancer, multivariate analysis in our study showed no association between MI and prognosis.…”

Nomogram for Predicting Recurrence-Free Survival in Chinese Women with Endometrial Cancer after Initial Therapy: External Validation

“…However, other studies found that, in low-risk patients with EC, positive peritoneal cytology did not affect the 5year disease-free survival rate [24,25]. Positive peritoneal cytology has also previously shown no effects on overall survival or disease-free survival in patients with low-or intermediate-risk disease [26,27]. In the present study, we found that positive peritoneal cytology was a critical and independent prognostic factor of EC recurrence in both cohorts.…”

Binary grading may be more appropriate for endometrial cancer

“…Given that peritoneal cytology is not a part of surgical staging, the relationship between survival and peritoneal cytology particularly is still very controversial in early-stage patients. While some studies showed positive peritoneal cytology is related to high rates of recurrences and poor survival ( 7 , 10 , 11 ), some found out no relationship between positive peritoneal cytology and survival ( 28 , 29 ). Seagle et al ( 30 ) analyzed data from the National Cancer Database and reported that adjuvant CT provides better survival in patients who were diagnosed as an early endometrioid type of endometrial cancer patients with positive peritoneal cytology.…”