| Background and objective:Endometrial carcinoma(EC)is a kind of gynecological malignant tumor which usually occurs in perimenopausal and postmenopausal women.Most patients were diagnosed in early stage,and the prognosis was favorable.The International Federation of Gynecology and Obstetrics(FIGO)stage of EC which consists of various clinicopathological factors can affect the patient’s prognosis.It plays a key role in predicting the prognosis and guiding the treatment of EC.As a clinicopathological factor,peritoneal cytology was no longer included in FIGO staging since 2009,but the effect of peritoneal cytology for EC patients was still controversial in recent years.This study aimed to determine the prognostic significance of positive peritoneal cytology(PPC)on EC patients,and analyze the risk factors which associated with PPC,and further explore the effect of PPC on the prognosis of EC patients under different pathological subtypes and risk groups.Materials and methods:This study retrospectively analyzed 6313 EC patients from 27 medical centers in China from 2000 to 2019.Patients were divided into positive PC group and negative PC group,and propensity score-based inverse treatment probability weighting(PS-IPTW)was used to balance the covariates.The chi-square test was used to compare the baseline characteristics of the cohorts before and after PS-IPTW,and the univariate and multivariate logistic regression analyzes were used to explore the risk factors associated with PPC.The prognostic significance of PC was evaluated by Kaplan-Meier curve among patients with different PC status.Univariate and multivariate Cox proportional hazards regression models were used to analyze the prognostic factors of EC patients and to determine whether PPC was an independent prognostic factor for EC patients.In the subgroup analysis,patients were divided into endometrioid endometrial carcinoma(EEC)and non-endometrioid endometrial carcinoma(non-EEC)according to different pathological types,and patients were divided into several risk groups according to the European Society of Gynecological Oncology(ESGO)guidelines,including the low-risk group,the intermediate-risk/high-intermediate-risk group and the high-risk group.Kaplan-Meier analysis and Cox regression models were used to evaluate the impact of PC on the prognosis of subgroups.The outcome variables of the study were progression-free survival(PFS)and overall survival(OS).Results:In this study,10,955 EC patients were collected from January 2000 to December 2019,of which 6,313 patients had PC results,and the detection rate of PC was 57.6%.A total of 6313 EC patients with PC results were enrolled in the final analysis,including 384 patients with PPC(6.1%)and 5929 patients with NPC(93.9%).The logistic regression model was used to explore which factors were relative to the results of PC.The results showed that preoperative hysteroscopy([Odd Ratio],OR=1.32,95%[Confidence Interval]CI:1.02-1.71,p=0.037),FIGO advance stage(OR=10.11,95%CI:3.23-35.05,p<0.001),non-EEC(OR=1.97,95%CI:1.35-2.86,p<0.001)were independent risk factors for PPC.In terms of survival outcomes,the median follow-up time of all patients was 44.4(1.0-224.9)months.The Kaplan-Meier survival analysis of 6313 EC patients showed that the prognosis of patients with PPC was worse(5-year PFS:82.8%vs.93.1%,5-year OS:88.4%vs.95.1%),and have statistically significant differences(all p<0.001).The multivariate Cox analysis showed that PPC was an independent prognostic factor for PFS([Hazard Ratio]HR=2.23,95%CI:1.57-3.14,p<0.001)and OS(HR=2.29,95%CI:1.53-3.44,p<0.001).In the subgroup analysis,patients were divided into EEC and non-EEC according to the pathological subtypes,and Kaplan-Meier curves showed that the prognosis of EEC patients was favorable,although the PFS and OS of patients with positive PC were worse than those with negative PC(5-year PFS:85.7%vs.94.2%,p<0.001;5-year OS:91.5%vs.96.2%,p=0.010)and had a statistically significant difference.The overall prognosis of non-EEC patients was poor,and PFS and OS of patients with positive PC were also worse than those with negative PC(5-year PFS:43.3%vs.76.1%,p=0.003;5-year OS:44.8%vs.78.7%,p<0.001),and had a statistically significant difference.In the other subgroup analysis according to the ESGO risk classifications,the Kaplan-Meier curves showed a poor survival of patients with PPC in the intermediate and high-intermediate risk group(5-year PFS:75.5%vs.93.0%,p<0.001;5-year OS:78.3%vs.96.4%,p<0.001)and had a statistically significant difference.While in the low-risk group,there were no significant differences in PFS and OS between different PC status(5-year PFS:93.1%vs.97.3%,p=0.124;5-year OS:98.6%vs.98.2%,p=0.823).In the high-risk group,significant difference was only found in PFS but not in OS(5-year PFS:62.5%vs.77.9%,P=0.033;5-year OS:71.3%vs.81.0%,p=0.071).Conclusions:1.Since 2009,the detection rate of PC in EC patients displayed a descending trend.Hysteroscopy,advanced FIGO staging and the pathological type of non-EEC are the independent risk factors for positive PC in EC patients.2.Positive PC is still an independent prognostic factor for EC patients.In the subgroup analysis,it was found that whether it was ECC or non-ECC,PPC had an adverse effect on the prognosis of EC patients.In the other subgroups analysis,PPC was an adverse prognostic factor in the intermediate/high-intermediate risk group and high risk group but not in the low risk group.3.Thus,in the clinical diagnosis and treatment of EC patients,gynecologic oncologists should pay more attention to the impact of positive PC,for further guiding the postoperative adjuvant treatment strategies. |
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