Significance of abnormal peritoneal cytology on survival of women with stage I-II endometrioid endometrial cancer

Koji Matsuo; Akira Yabuno; Marianne S Hom; Masako Shida; Mamoru Kakuda; Sosuke Adachi; Rachel S Mandelbaum; Yutaka Ueda; Kosei Hasegawa; Takayuki Enomoto; Mikio Mikami; Lynda D Roman

doi:10.1016/j.ygyno.2018.02.012

Significance of abnormal peritoneal cytology on survival of women with stage I-II endometrioid endometrial cancer

Gynecol Oncol. 2018 May;149(2):301-309. doi: 10.1016/j.ygyno.2018.02.012. Epub 2018 Mar 28.

Authors

Affiliations

¹ 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. Electronic address: koji.matsuo@med.usc.edu.
² Department of Obstetrics and Gynecology, Saitama University International Medical Center, Saitama, Japan.
³ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
⁵ Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
⁶ Department of Obstetrics and Gynecology, Niigata University School of Medicine, Osaka, Japan.
⁷ 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.

Abstract

Objective: To examine survival of women with stage I-II endometrioid endometrial cancer whose peritoneal cytology showed malignant or atypical cells (abnormal peritoneal cytology).

Methods: This is a multi-center retrospective study examining 1668 women with stage I-II endometrioid endometrial cancer who underwent primary hysterectomy with available peritoneal cytology results between 2000 and 2015. Abnormal peritoneal cytology was correlated to clinico-pathological characteristics and oncological outcome.

Results: Malignant and atypical cells were seen in 125 (7.5%) and 58 (3.5%) cases, respectively. On multivariate analysis, non-obesity, non-diabetes mellitus, cigarette use, and lympho-vascular space invasion were independently associated with abnormal peritoneal cytology (all, P<0.05). Abnormal peritoneal cytology was independently associated with decreased disease-free survival (hazard ratio 3.07, P<0.001) and cause-specific survival (hazard ratio 3.42, P=0.008) on multivariate analysis. Abnormal peritoneal cytology was significantly associated with increased risks of distant-recurrence (5-year rates: 8.8% versus 3.6%, P=0.001) but not local-recurrence (5.2% versus 3.0%, P=0.32) compared to negative cytology. Among women with stage I disease, abnormal peritoneal cytology was significantly associated with an increased risk of distant-recurrence in the low risk group (5-year rates: 5.5% versus 1.0%, P<0.001) but not in the high-intermediate risk group (13.3% versus 10.8% P=0.60). Among 183 women who had abnormal peritoneal cytology, postoperative chemotherapy significantly reduced the rate of peritoneal recurrence (5-year rates: 1.3% versus 9.2%, P=0.039) whereas postoperative radiotherapy did not (7.1% versus 5.5%, P=0.63).

Conclusion: Our study suggests that abnormal peritoneal cytology may be a prognostic factor for decreased survival in women with stage I-II endometrioid endometrial cancer, particularly for low-risk group.

Keywords: Endometrial cancer; Low risk; Peritoneal cytology; Recurrence; Survival.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Endometrioid / mortality
Carcinoma, Endometrioid / pathology*
Endometrial Neoplasms / mortality
Endometrial Neoplasms / pathology*
Female
Humans
Logistic Models
Middle Aged
Neoplasm Staging
Peritoneum / pathology*
Retrospective Studies

Grants and funding

P30 CA014089/CA/NCI NIH HHS/United States