Prognosis and treatment of positive peritoneal cytology in early endometrial cancer: matched cohort analyses from the National Cancer Database

Seagle, Brandon Luke L.; Alexander, Amy L.; Lantsman, Taliya; Shahabi, Shohreh

doi:10.1016/j.ajog.2017.11.601

Cited by 70 publications

(75 citation statements)

References 11 publications

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“…Although new staging guidelines do not include positive peritoneal cytology as a parameter and prognosis remains uncertain, one recent study [4] performed on a large cohort of patients proved that positive peritoneal cytology was associated with decreased overall survival for women with FIGO I/II stage, including those with low-grade endometrioid endometrial carcinoma. 64% of our cases showed tumor size >2 cm with 14% associated lymph node metastasis and 5% of cases with previous histopathological diagnosis of endometrial hyperplasia without or with atypia.…”

Section: Resultsmentioning

confidence: 99%

Molecular Subgroups of Endometrial Carcinoma in Romanian Patients

Evsei¹,

Birceanu-Corobea²,

Csonka³

et al. 2020

Rev. Chim.

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Molecular classification of endometrial carcinoma (EC) has represented a breakthrough ever since the TCGA (The Cancer Genome Atlas) project published it in 2013. Four distinct molecular subgroups were recognized based on somatic copy number alterations and tumor mutational burden: POLE (polymerase-epsilon) ultramutated, MSI (microsatellite instability) hypermutated (MSI-H), copy number low (CNL) and copy number high (CNH). However, implementing a standardized algorithm in current practice is far from being definitive. Our purpose in this study was to determine different molecular subgroups in a cohort of Romanian patients using cost effective and available immuno-histochemistry markers and outline statistical associations with different parameters. Tissue microarrays encompassing 50 cases with previously diagnosed ECs were tested for ER, PR, HER2, p53, MSH6 and PMS2 and results showed 68% MSI-H cases with statistical correlation with tumor size ] 2 cm (p=0.028) and no association with overall survival. CNH ECs were reported in 26% of cases and showed important statistical significance with TILs (p=0.041) and no correlations with overall survival. The CNL subgroup was reported in 74% of ECs cases and showed statistical significance with the histopathological subtype (p=0.006), pT (removal of primary tumor according to AJCC/UICC convention) (p=0.033), risk category according to ESMO (European Society of Medical Oncology) criteria (p=0.022) and ER expression (p=0.002). Five-year overall survival was 84%. Molecular classification is an important additional tool in current pathology guidelines for reporting ECs, but it is not currently standardized or available in all laboratories. Its importance in evolving treatment strategies for this disease is well documented so we strongly recommend routine testing for molecular prognostic factors.

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Section: Resultsmentioning

confidence: 99%

Molecular Subgroups of Endometrial Carcinoma in Romanian Patients

Evsei¹,

Birceanu-Corobea²,

Csonka³

et al. 2020

Rev. Chim.

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“…e influence of the peritoneal cytology status on the prognosis of women with EC remains and should be further evaluated. Previous multivariate analyses have revealed that positive peritoneal cytology could predict relapse and tumor-related death in early-stage EC [19][20][21][22][23]. 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].…”

Section: Journal Of Oncologymentioning

confidence: 99%

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

Cheng

Dong

Tian

et al. 2020

Journal of Oncology

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This study aimed at developing an available recurrence-free survival (RFS) model of endometrial cancer (EC) for accurate and individualized prognosis assessment. A training cohort of 520 women with EC who underwent initial surgical treatment and an external validation cohort of 445 eligible EC patients from 2006 to 2016 were analyzed retrospectively. Multivariable Cox proportional hazards regression models were used to develop nomograms for predicting recurrence. The concordance index (C-index) and the area under the receiver operating characteristic curve (AUC) were calculated to determine the discrimination of RFS prognostic scoring systems. Calibration plots were generated to examine the performance characteristics of the predictive nomograms. Regression analysis revealed that an advanced International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade 3, primary tumor diameter ≥2 cm, and positive peritoneal cytology were independent prognostic factors for RFS in EC in the training set. The nomograms estimated RFS according to these four variables, with a C-index of 0.860, which was superior to that of FIGO stage (2009 criteria), at 0.809 (P=0.034), in the training cohort. Encouragingly, consistent results were observed in the validation set, with a C-index of 0.875 for the nomogram and a C-index of 0.833 for the FIGO staging (P=0.0137). Furthermore, the calibrations of the nomograms predicting 3- and 5-year RFS strongly corresponded to the actual survival outcome. In conclusion, this study developed an available nomogram with effective external validation and relatively appreciable discrimination and conformity for the accurate assessment of 3- and 5-year RFS in Chinese women with EC.

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“…They have stated that they hoped that with further data， peritoneal cytology would be added back into the surgical staging for EC. 19 Some scholars believe that positive peritoneal cytology is not an independent risk factor for the prognosis of EC. [5][6][7][8][9][10] However, since the publication of the revised 2009 FIGO staging criteria, only one study has shown that positive peritoneal cytology is not a high-risk factor for prognosis.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…4 Although a limited number of articles have suggested that positive cytology is not an independent risk factor for adverse outcomes, [5][6][7][8][9][10] recent studies have repeatedly emphasized that positive peritoneal cytology is still associated with poor prognosis, even when other confounding factors are adjusted. [11][12][13][14][15][16][17][18][19][20] The prognostic value of peritoneal cytology in EC patients remains controversial. Therefore, we aimed to clarify whether positive peritoneal cytology was an independent risk factor in EC patients through a retrospective study in EC patients.…”

Section: Introductionmentioning

confidence: 99%

Positive peritoneal cytology is an independent risk factor in endometrial cancer

Dong

Wang

2020

J of Obstet and Gynaecol

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Objective We aimed to investigate whether positive peritoneal cytology could serve as a prognostic factor in endometrial cancer (EC). Methods From patients with EC surgically treated at Peking University People's Hospital between 2006 and 2016, 520 patients were selected for retrospective investigation. Clinical and pathologic factors associated with positive peritoneal cytology were assessed using univariate and multivariate logistic regressions model. Disease‐free survival (DFS) and overall survival (OS) were evaluated using Kaplan–Meier estimation and multivariate Cox regressions model. Results (i) The incidence of positive peritoneal cytology in EC patients was 9.0% (47/520). (ii) Multivariate analysis showed that the independent risk factors of positive peritoneal cytology were nonendometrioid carcinoma (odds ratio [OR] = 4.0, 95% confidence interval [CI], 1.8–8.8, P = 0.001), tumor diameter ≥2 cm (OR = 3.2, 95% CI, 1.2–8.7, P = 0.023), cervical stromal invasion (OR = 2.9, 95% CI, 1.3–6.6, P = 0.009) and distant metastasis (OR = 6.5, 95% CI, 1.7–25.4, P = 0.007). (iii) The 5‐year DFS and 5‐year OS of the positive peritoneal cytology group were significantly lower compared with the negative group (54.0% vs 93.2%, P < 0.001; 63.6% vs 94.6%, P < 0.001). (iv) After other contributing factors were adjusted in the multivariable model, positive peritoneal cytology remained an independent predictor of decreased DFS (OR = 2.8, 95% CI, 1.3–6.0, P = 0.007) and OS (OR = 2.8, 95% CI, 1.0–7.2, P = 0.035). Conclusion Positive peritoneal cytology was an independent risk factor in EC patients. Even though it is no longer an indicator according to the current International Federation of Gynecology and Obstetrics staging system, the peritoneal cytology status should still be considered for accurate risk stratification in EC.

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Prognosis and treatment of positive peritoneal cytology in early endometrial cancer: matched cohort analyses from the National Cancer Database

Cited by 70 publications

References 11 publications

Molecular Subgroups of Endometrial Carcinoma in Romanian Patients

Molecular Subgroups of Endometrial Carcinoma in Romanian Patients

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

Positive peritoneal cytology is an independent risk factor in endometrial cancer

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