Abstract
This study examined the association between peritoneal cytology and survival in early-stage cervical cancer. This is a nationwide multicenter retrospective study, examining consecutive women with clinical stage IB1-IIB cervical cancer who underwent radical hysterectomy with available peritoneal cytology results from 2004–2008. Propensity score inverse probability of treatment weighting was used to assess the impact of malignant peritoneal cytology on survival. Among 1409 analyzed cases, 88 (6.2%) had malignant peritoneal cytology. On weighted models, malignant peritoneal cytology was associated with decreased disease-free survival (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.36–2.32) and overall survival (OS, HR 1.93, 95% CI 1.44–2.59). On sensitivity analyses, malignant peritoneal cytology was associated with decreased OS in adenocarcinoma/adenosquamous carcinoma, high-risk early-stage disease and those who received concurrent chemo-radiotherapy. However, among women who received postoperative systemic chemotherapy, malignant peritoneal cytology was not associated with OS (HR 1.21, 95% CI 0.72–2.04). A systematic review, including our results, showed that malignant peritoneal cytology was associated with decreased OS (HR 4.03, 95% CI 1.81–8.99) and increased recurrence in squamous carcinoma (odds ratio 1.89, 95% CI 1.05–3.39) and adenocarcinoma (odds ratio 4.30, 95% CI 2.30–8.02). In conclusion, the presence of malignant cells in peritoneal cytology is associated with decreased survival in early-stage cervical cancer. The possible benefit of systemic chemotherapy in this subgroup merits further investigation.
Highlights
Cervical cancer is commonly associated with persistent oncogenic human papillomavirus (HPV) infection
Institutional Review Board approval was obtained at Tottori University, (National University Corporation Tottori University, Tottori, Empire of Japan), which served as the host institution, and participating Japanese Gynecologic Oncology Group (JGOG)-participating institutions obtained their own approvals at each site as indicated
Iinthwnoomne-andwenhoocuarncdineorwmeanht ipsrtoimloagryy, stuhregeurtyiliftoyr osftapgeerIiBto1ndeaislecaysetowloigthy nwoans-aadselnoowcaarcsin0.o5m%ar.itoneal cytology was as low as 0.5%
Summary
Cervical cancer is commonly associated with persistent oncogenic human papillomavirus (HPV) infection. There has long been an interest in determining if the presence of malignant cells in the peritoneal cytology is a possible surgical-pathological risk factor in cervical cancer [5]; the prognostic significance in women with early-stage cervical cancer has not been well studied [6,7,8,9,10]. Overall, these prior studies have been limited by small sample size, examination of only certain histology types, or have grouped advanced-stage disease together with early-stage disease, leaving the findings difficult to interpret, in the setting of early-stage disease [6,7,8,9,10,11,12,13,14,15,16]
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