Prognostic Significance Of Peritoneal Cytology Research Articles

Prognostic significance of right subdiaphragmatic washing cytology in patients with endometrial cancer

Cancer cells in the right subdiaphragmatic lavage may reflect peritoneal dissemination, but its prognostic significance is unknown. This study investigated recurrence-free survival (RFS), overall survival (OS), and recurrence patterns in patients with curatively resected endometrial cancer by cytology collection site. Peritoneal cytology was collected at the beginning of surgery by washing the pelvic and right subdiaphragmatic cavity separately. The analysis included 465 patients with the median follow-up duration of 121 months. Of these, 62 (13%) patients had positive pelvic cytology and 22 (5%) patients had positive right subdiaphragmatic cytology. Patients positive for right subdiaphragmatic cytology were all positive for pelvic cytology, showing the worst RFS and OS among the study population. Multivariate analyses showed positive right subdiaphragmatic cytology, not pelvic cytology, significantly correlated with shorter RFS and OS when adjusted for clinicopathological factors. Patients with both pelvic and right subdiaphragmatic positive cytology had significantly higher peritoneal recurrence rates than those negative at both sites. However, patients with only positive pelvic cytology showed no significant difference in the recurrence rate. Our results suggest that the prognostic significance of peritoneal cytology may differ depending on the collection site in endometrial cancer and provide new insights to select patients for adjuvant therapy.

Prognostic significance of peritoneal cytology in low-risk endometrial cancer: comparison of laparoscopic surgery and laparotomy

BackgroundThere is uncertainty surrounding the prognostic value of peritoneal cytology in low-risk endometrial cancer, especially in laparoscopic surgery. The objective of this retrospective study is to determine the prognostic significance of positive peritoneal cytology among patients with low-risk endometrial cancer and to compare it between laparoscopic surgery and conventional laparotomy.MethodsFrom August 2008 to December 2019, all cases of pathologically confirmed stage IA grade 1 or 2 endometrial cancer were reviewed at Osaka Medical College. Statistical analyses used the Chi-square test and the Kaplan–Meier log rank.ResultsA total of 478 patients were identified: 438 with negative peritoneal cytology (232 who underwent laparotomy and 206 who undertook laparoscopic surgery) and 40 with positive peritoneal cytology (20 who underwent laparotomy and 20 who received laparoscopic surgery). Survival was significantly worse among patients with positive peritoneal cytology compared to patients with negative peritoneal cytology. However, there was no significant difference among patients with negative or positive peritoneal cytology between laparoscopic surgery and laparotomy.ConclusionThis retrospective study suggests that, while peritoneal cytology is an independent risk factor in patients with low-risk endometrial cancer, laparoscopic surgery does not influence the survival outcome when compared to laparotomy.

The prognostic significance of peritoneal cytology in patients with gastric cancer after a curative resection

The prognostic significance of peritoneal cytology in patients with gastric cancer after a curative resection

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

ObjectivesThere is uncertainty surrounding the prognostic value and clinical utility of peritoneal cytology in endometrial cancer. Our primary objective was to determine if positive cytology is associated with disease-free and overall survival in women treated surgically for endometrial cancer, specifically those with low or intermediate risk disease. MethodsThis was a retrospective population-based cohort study of British Columbia Cancer Registry patients who underwent surgery with peritoneal washings for endometrioid-type endometrial cancer from 2003 to 2009. Low risk was defined as Stage IA grade 1 or 2, and intermediate risk defined as Stage IA grade 3, or Stage IB grade 1 or 2 tumours. Five-year overall and disease free-survival were assessed using Kaplan-Meier estimation. Potential covariates including peritoneal cytology, grade, depth of myometrial invasion, LVSI, age, and adjuvant therapy were evaluated in a multivariable Cox proportional hazards model. ResultsThere were 849 patients, of whom 370 (43.6%) and 298 (35.1%) had low- and intermediate-risk disease, respectively. Overall, forty-nine (5.8%) patients had positive cytology, including 6 and 9 with low- and intermediate-risk respectively (2.2% within low and intermediate risk combined). Positive peritoneal cytology was not significantly associated with disease-free (HR 3.17, 95% CI 0.91–11.03) or overall survival (HR 1.33, 95% CI 0.47–3.76) in low and intermediate risk patients. Only age and extensive LVSI were associated with lower overall survival (HR 1.10, 95% CI 1.08–1.13, and HR 2.39, 95% CI 1.02–5.61, respectively). ConclusionsPositive peritoneal cytology was not associated with disease-free and overall survival in women with low and intermediate risk endometrial cancer.

EVOCAPE 2 study: Lack of prognostic significance of conventional peritoneal cytology in colorectal and gastric cancer?

With great interest we read the article by Cotte et al.1 concerning the prognostic significance of peritoneal cytology in colorectal and gastric cancer. The authors performed a prospective multicentre analysis on the prognostic significance of intraperitoneal free cancer cells (IPCC) in 1364 patients with various gastrointestinal malignancies. The authors concluded that IPCC was not an independent prognostic factor and did not add any additional prognostic information to known tumour related prognostic factors.

Reply to: EVOCAPE 2 study: Lack of prognostic significance of conventional peritoneal cytology in colorectal and gastric cancer?

We appreciate the interest that Braam et al. have paid to the results of our study EVOCAPE 2. 1 Cotte E. Peyrat P. Piaton E. et al. Lack of prognostic significance of conventional peritoneal cytology in colorectal and gastric cancers: results of EVOCAPE 2 multicentre prospective study. Eur J Surg Oncol. 2013; 39: 707-714 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar They suggest that the conclusions concerning the prognostic significance of intraperitoneal free cancer cells (IPCC), especially for the development of PC in gastric cancer should be interpreted with caution. We totally agree with them. The main message of our study was that conventional cytology is probably not useful for colorectal and gastric cancers because of its low rate of positivity. It does not bring any additional information in term of recurrence risk or survival than usual prognostic factors (TNM, differentiation…). Despite a standardized procedure for cytology and a panel of 7 cytopathologists for interpretation, the prevalence of IPCC remained low in our study. EVOCAPE 2 study: Lack of prognostic significance of conventional peritoneal cytology in colorectal and gastric cancer?European Journal of Surgical OncologyVol. 39Issue 11PreviewWith great interest we read the article by Cotte et al.1 concerning the prognostic significance of peritoneal cytology in colorectal and gastric cancer. The authors performed a prospective multicentre analysis on the prognostic significance of intraperitoneal free cancer cells (IPCC) in 1364 patients with various gastrointestinal malignancies. The authors concluded that IPCC was not an independent prognostic factor and did not add any additional prognostic information to known tumour related prognostic factors. Full-Text PDF

Clinicopathological analysis and prognostic significance of peritoneal cytology in Chinese patients with advanced gastric cancer

The influence of peritoneal cytology on survival of patients with gastric cancer has not been consistent. This study was to identify risk factors for positive peritoneal cytology and to evaluate the predictive value of positive cytology among Chinese patients with advanced gastric cancer. The study included 139 patients with gastric cancer macroscopically invading the serosa, who underwent gastrectomy and intra-operative peritoneal cytological examination. In these patients, the relationship between cytological positivity and various clinicopathological features was analysed, and survival analysis was performed to identify independent prognostic factors of significance. Thirty-eight (27.3%) of 139 patients had positive peritoneal cytology. Although tumour size, lymphovascular invasion, depth of tumour invasion, lymph node metastasis and peritoneal metastasis were correlated with positive cytology, multivariate analysis revealed the depth of tumour invasion and peritoneal metastasis as the independent features affecting the cytology. Patients with a positive cytology result were confirmed to have a greater risk for recurrence in the pattern of peritoneal carcinomatosis and a significant inferior prognosis. Multivariate analysis indicated that positive peritoneal cytology was an independent prognostic factor among the curatively resected patients with advanced gastric cancer and was the prognostic factor most predictive of death for these patients (risk ratio = 2.74). Positive peritoneal cytology correlated with advanced features of gastric cancer. It is an independent poor prognostic factor, and it may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer.

Prognostic Value of Peritoneal Cytology and the Combination of Peritoneal Cytology and Peritoneal Dissemination in Colorectal Cancer

The value of positive peritoneal cytology in colorectal cancer has been controversial. In this study, we aimed to clarify the prognostic significance of peritoneal cytology and the impact of the combination of peritoneal dissemination and peritoneal cytology on the prognostic evaluation of colorectal cancer. From January 1997 to December 2005, intraoperative peritoneal cytology was performed on 410 patients who had at least serosal invasion. Thirty-one patients (7.6%) had positive peritoneal cytology. Patients with negative cytology showed a significantly better survival rate at five years than those with positive cytology (negative cytology, 68.0%; positive cytology, 20.6%; P < 0.0001). Multivariate analysis revealed that peritoneal cytology is one of the significant prognostic factors. Sixty percent of patients with positive cytology and 30.4% of patients with negative cytology recurred (P = 0.08). Regarding the recurrence site, patients with positive cytology showed a significantly higher recurrence rate of peritoneal dissemination than those with negative cytology (P = 0.0038). Some patients with positive cytology but without evident peritoneal dissemination achieved long-term survival. Additionally, some patients with macroscopic peritoneal dissemination and negative peritoneal cytology also achieved long-term survival. But for those patients with both positive cytology and evident macroscopic peritoneal dissemination, the five-year survival rate was zero. Patients with negative peritoneal cytology had a significantly better five-year survival rate than those with positive peritoneal cytology. In some cases in which either peritoneal cytology or peritoneal dissemination was negative, long-term survival could be achieved.

Prognostic significance of positive peritoneal cytology in adenocarcinoma of the uterine cervix

Objective A retrospective analysis was carried out to evaluate the prognostic significance of peritoneal cytology in cervical adenocarcinoma. Methods The records of 107 patients with FIGO stage IB to IIB cervical adenocarcinoma who underwent hysterectomy were reviewed. Results Sixteen patients (15%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative cytology was 50% or 87%, respectively, showing a significant difference (log-rank, P < 0.001). The recurrence-free survival (RFS) rate at 36 months in the cytology-positive or –negative group was 53% or 87%, respectively, the difference being significant (log-rank, P = < 0.001). Cox model analysis revealed positive cytology [hazards ratio (HR) 6.27, 95% confidence interval (CI) 2.13–18.41], positive lymph node (HR 6.20, 95% CI 1.87–20.57), ovarian metastasis (HR 5.20, 95% CI 1.18-22.82), and histological grade (HR 5.97, 95% CI 2.00-17.78) to be independent adverse risk factors for survival among the factors analyzed (lymph node status, lymph-vascular space invasion, tumor size, depth in cervical wall, pathological parametrial involvement, infiltration to vagina, ovarian metastasis, and histological grade). Cox model analysis showed that positive cytology (HR 4.58, 95% CI 1.48–14.16), positive lymph node (HR 7.61, 95% CI 2.69–21.54), and histological grade (HR6.13, 95% CI 2.14–17.77) were independent adverse risk factors for RFS. The incidence of peritoneal spread at the first recurrence among the cytology-positive group (62.5%) was significantly higher than that among the cytology-negative group (12.5%) (Fisher's exact test, P = 0.021). Conclusion The presence of positive peritoneal cytology appears to be an independent prognostic risk factor in patients with cervical adenocarcinoma.

Positive peritoneal cytology and its prognostic value in endometrioid adenocancer confined to the uterus

The aim of this study was to evaluate the prognostic significance of peritoneal cytology in patients with endometrioid adenocarcinoma limited to the uterus. A retrospective study was performed on 46 patients with surgically staged endometrioid adenocarcinoma that was histologically confined to the uterus. Patients who had negative nodes, disease localized to the uterus and endometrioid subtype were included. The Chi-square (χ 2) test was used for statistical analysis. Disease free survival rates calculated by the Kaplan-Meier method, and log-rank test was used for comparison. Stepwise Cox proportional hazard model was used to assess the independent prognostic and predictive factors affecting disease free survival. The median duration of the follow-up period was 36 months (1–104 months). Peritoneal cytology was positive in 4 patients (8.7%). The disease-free survival rate at 36 months was 50% among patients with positive cytology, compared with that of 92.9% among patients with negative cytology, and the difference was significant (log-rank, P = 0.036). Multivariate analysis revealed that peritoneal cytology was independent prognostic factor (P = 0.016; OR: 9.0; 95% Cl: 1.497–54.179) of disease-free survival in patients with endometrial carcinoma confined to the uterus. We concluded that the presence of positive peritoneal cytology is an independent prognostic factor in patients with endometrial carcinoma confined to the uterus.

Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus.

A retrospective analysis was performed to evaluate the prognostic significance of peritoneal cytology in patients with endometrial carcinoma limited to the uterus. A total of 280 patients with surgically staged endometrial carcinoma that was histologically confined to the uterus were examined clinicopathologically. The median length of follow-up was 62 (range, 12–135) months. All patients underwent hysterectomy and salpingo-oophorectomy with selective lymphadenectomy, and only three patients received adjuvant postoperative therapy. No preoperative adjuvant therapy was employed. In all, 48 patients (17%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative peritoneal cytology was 91 or 95%, respectively, showing no significant difference (log-rank, P=0.42). The disease-free survival rate at 36 months was 90% among patients with positive cytology, compared with that of 94% among patients with negative cytology, and the difference was not significant (log-rank, P=0.52). Multivariate proportional hazards model revealed only histologic grade to be an independent prognostic factor of survival (P=0.0003, 95% CI 3.02 – 40.27) among the factors analysed (age, peritoneal cytology, and depth of myometrial invasion). Multivariate analysis revealed that histologic grade (P=0.02, 95% CI 1.21–9.92) was also the only independent prognostic factor of disease-free survival. We concluded that the presence of positive peritoneal cytology is not an independent prognostic factor in patients with endometrial carcinoma confined to the uterus, and adjuvant therapy does not appear to be beneficial in these patients.

Positive peritoneal cytology is an adverse factor in endometrial carcinoma only if there is other evidence of extrauterine disease

The prognostic significance of peritoneal cytology among 269 women with clinical stage I and II carcinoma of the endometrium was studied. All patients were surgically staged and had undergone selective pelvic and para-aortic lymphadenectomies. Patients with clear cell and papillary serous carcinomas were excluded from the analysis. Thirty-four (12.6%) patients had malignant cells in the peritoneal washings (positive peritoneal cytology). The effect of positive peritoneal cytology on survival depended upon the extent of disease present. If the disease was confined to the uterus, positive peritoneal cytology did not influence survival; if the disease had spread to the adnexa, lymph nodes, or peritoneum, positive peritoneal cytology had a significant adverse effect on survival, decreasing it at 5 years from 73 to 13%, all recurrences being at distant sites. These findings suggest that treatment specifically directed at positive peritoneal cytology is not warranted unless extrauterine disease is present, and when it is, systemic rather than intra-abdominal treatment will be required to affect survival.

Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intraperitoneal radiopharmaceuticals

One hundred sixty-seven patients with clinical State I carcinoma of the endometrium were treated primarily by operation consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and para-aortic lymphadenectomy, and cytologic testing of peritoneal washings. Twenty-six (15.5%) of the 167 patients had malignant cells identified on cytologic examinations of peritoneal washings. Recurrence developed in 10 of these 26 (34.0%) compared to 14/141 (9.9%) patients with negative cytologic testing. Of the 26 patients, 13 (50%) had disease outside of the uterus at operation and seven have died of disease (54%). Thirteen patients had malignant cells in the peritoneal washings but no disease outside of the uterus and six (46%) of these have died of disseminated intra-abdominal carcinomatosis. On the basis of the poor outcome of those patients who had malignant cells in the peritoneal washings in the 167 patients studied, a plan of treating such patients with intraperitoneal radioactive chromic phosphate suspension (P-32) was instituted. Twenty-three subsequent patients with clinical Stage I carcinoma of the endometrium were found to have malignant cells in the peritoneal fluid. All 23 received intra-abdominal P-32 suspension instillation after operation. There have been three recurrences with two patients dying of disease. All of the three recurrences appeared at sites distant from the abdominal cavity. Peritoneal cytologic examination appears to be an important factor in the prognosis of endometrial cancer and, when the washings are positive for malignant cells, intraperitoneal chronic phosphate therapy appears to be efficacious.