Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer
Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer
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DOI：
10.1038/modpathol.3800342
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发表时间：
2005-05-01
期刊：
影响因子：
7.5
通讯作者：
Rimm, DL
中科院分区：
文献类型：
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作者：
Fadare, O;Mariappan, MR;Rimm, DL
子宫内膜癌的手术分期包括腹腔和骨盆的腹膜冲洗。一个积极的发现提前患者到国际妇产联合会IIIA期。然而，这种占上风的预后意义，以及常规执行该手术的理由尚不清楚。这项为期5年的回顾性研究旨在确定仅基于阳性洗涤的子宫内膜癌分期的频率和预后意义。该研究的队列是通过回顾5年间（1995年1月- 1999年12月）所有因怀疑子宫内膜癌而行子宫切除术前清洗的病理报告收集的。如果没有明显的腹腔内疾病，没有子宫外肿瘤的组织学证据，则选择细胞学阳性的病例，否则这些病例将被认为是I期或II期（病例组）。选取具有相同组织学亚型且洗涤阴性的I期和II期患者作为年龄匹配的对照组（n = 19）。在220例子宫内膜癌中，19例（8.6%）腹膜洗涤细胞学异常，仅10例（占所有病例的4.5%，8例子宫内膜样，1例浆液性，1例混合性；9例IA或IB期和1例IIB期）。90%的病例组和74%的对照组接受了辅助治疗。在中位随访51个月（病例组）和63个月（对照组）后，我们发现对照组中只有1例患者出现疾病进展（复发、转移或死亡）。结论是，没有其他子宫外疾病证据的异常细胞学导致少数子宫内膜癌患者（4.5%）的分期上升，但似乎不影响其整体预后。虽然这是一个小的单点研究，但它提出了关于子宫内膜癌患者该手术的价值的问题。
Surgical staging of endometrial carcinoma includes the collection of peritoneal washings in the abdomen and pelvis. A positive finding upstages patients to International Federation of Gynecology and Obstetrics stage IIIA. However, the prognostic significance of such an upstaging, and thus the justification for the routine performance of this procedure, is unclear. This 5-year retrospective study was conducted to determine the frequency and prognostic significance of upstaging of endometrial carcinoma based solely on positive washings. The cohort for the study was collected by review of pathology reports of all washings that were performed prior to hysterectomies for suspected endometrial carcinomas over a 5-year period (01/1995 - 12/ 1999). Cases with positive cytology were selected if there was no grossly apparent intraperitoneal disease, no histologic evidence of extra-uterine tumor and the cases would otherwise have been considered stage I or II ( case group). An age-matched control group was selected of stage I and II patients with the same histologic subtypes and negative washings ( n = 19). Of 220 endometrial carcinomas, peritoneal washing cytology was abnormal in 19 (8.6%) and was solely responsible for upstaging only 10 patients (4.5% of all cases, eight endometrioid, one - serous, one - mixed; nine stage IA or IB and one stage IIB). Adjuvant therapy was administered in 90% of the case group and 74% of the control group. After a median follow-up of 51 months ( case group) and 63 months ( control group), we found only a single patient with progression of disease ( recurrence, metastases or death) in the control group. It is concluded that abnormal cytology without other evidence of extrauterine disease leads to upstaging of a minority of endometrial carcinoma patients ( 4.5%), but does not appear to affect their overall outcome. Although this is a small single site study, it raises questions about the value of this procedure in patients with endometrial cancer.