Prognostic significance of peritoneal cytology in low-intermediate risk endometrial cancer

Scott, Stephanie; Zanden, Carlijn van der; Cai, Eric; McGahan, Colleen; Kwon, Janice S.

doi:10.1016/j.ygyno.2017.03.011

Cited by 35 publications

(19 citation statements)

References 19 publications

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“…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]. 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].…”

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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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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“…[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. 10 In 2017, Scott et al, 10 have analyzed 668 patients with stage I EC, and shown that patients with positive peritoneal cytology have inferior OS and DFS compared with the subjects with negative cytology. However, after other confounding factors in the multivariable Cox model were adjusted, there was no longer a significant association between the peritoneal cytology and outcome.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…No clear explanation or rationale has been offered in the new staging system to explain the continuous request to collect cytology although its results do not affect clinical care. 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.…”

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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“…The level of evidence was therefore downgraded from high to moderate. Furthermore, because of this lack of precision and the variable clinical significance, it was decided to form a conditional (weak) recommendation [5].…”

Section: Regarding "5-millimeter Trocar Site Hernias After Laparoscopmentioning

confidence: 99%

Regarding “Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation”

Parker¹,

Berek²,

Pritts³

et al. 2018

Journal of Minimally Invasive Gynecology

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Tissue morcellation is under scrutiny as gynecologists try to avoid morcellation of occult leiomyosarcoma (LMS). Reports suggest a very low prevalence of LMS among women undergoing surgery for symptomatic myomas. Damasco et al [1] reported that among 1878 women undergoing myomectomy or hysterectomy for presumed myomas, none was found to have LMS. A meta-analysis of 134 studies including 30 193 patients reported an LMS prevalence of 1 in 1960 [2]. The study reported by Wasson et al [3] contends that vaginal morcellation can protect against inadvertent spread of morcellated tissue. Evidence suggests that this conclusion may be incorrect, however. In the often-cited study by Park et al [4] describing decreased survival following morcellation, the vast majority of women underwent laparoscopically assisted vaginal hysterectomy with scalpel morcellation performed through the vagina. This is the procedure that Wasson et al purport to be safe. Only 1 of the 25 the women in that study underwent laparoscopic surgery with electromechanical morcellation. In the study reported by Park et al and other studies, the patient numbers are very small and the data poorly analyzed. Importantly, Wasson et al found no women with LMS among the 611 women who had undergone morcellation during vaginal hysterectomy. Although morcellation of a grade 1 endometrial adenocarcinoma (3 patients) should be avoided, there are no data to suggest that morcellation has an effect on local recurrence or overall survival for that disease. Women with positive peritoneal washing cytology at the time of hysterectomy for endometrial cancer, either spontaneous or introduced during hysteroscopy, have no difference in prognosis compared with women with negative cytology [5]. Lowgrade endometrial stromal sarcoma (2 women) is a biologically indolent tumor with a much less malignant behavior compared with LMS. It has a 5-year survival of 90%, and there is no evidence suggesting that morcellation influences survival in these women. Using laparoscopic visualization, we recently recorded vaginal morcellation of a large uterus (566 g). [Supplementary Video] Inspection of the peritoneal cavity at the end of the procedure revealed multiple tissue fragments. Staying "inside the serosa" may be a good concept, but the ability to achieve that with a large uterus and multiple myomas is uncertain. Inspection for and retrieval of tissue fragments followed by copious irrigation and suctioning of cells is available under laparoscopic guidance, but not available during vaginal surgery. Taking time to inspect, retrieve tissue fragments, perform irrigation, and suction fluids may be another reasonable solution that merits investigation. Gynecologists should withhold judgment regarding morcellation based on unscientific pressure from the media or

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Prognostic significance of peritoneal cytology in low-intermediate risk endometrial cancer

Cited by 35 publications

References 19 publications

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

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

Regarding “Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation”

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