ABSTRACT
Objective:To investigate the risk factors of positive peritoneal cytology (PPC) in patients with endometrial cancer and the impact of PPC on patients' prognosis.Methods:The clinicopathological data of 202 patients who underwent initial surgical treatment and were diagnosed with endometrial cancer by postoperative pathology at Qilu Hospital of Shandong University from January 2015 to December 2019 were retrospectively analyzed, and the peritoneal fluid of patients were sent intraoperatively for cytological liquid-based smear examination. Logistic regression was used to perform univariate and multivariate analyses of PPC in the whole group of patients and the early-stage patients; Univariate analysis of the progression-free survival in the whole group of patients and the early-stage patients was performed by Kaplan-Meier method and compared by log-rank method, and multivariate analysis of the progression-free survival in the whole group of patients and the early-stage patients was performed by Cox proportional hazards model.Results:Of 202 patients, 183 (90.6%) had negative peritoneal cytology (NPC) and 19 (9.4%) had PPC; 180 patients (89.1%) were stage Ⅰ-Ⅱ and 22 (10.9%) were stage Ⅲ-Ⅳ; 180 patients (89.1%) had early-stage endometrial cancer. Deep myometrial infiltration ( OR = 3.57, 95% CI 1.02-12.45, P = 0.046) and lymph node metastasis ( OR = 7.16, 95% CI 1.70-30.23, P = 0.007) were independent risk factors for PPC in patients with endometrial cancer; deep myometrial infiltration was an independent risk factor for PPC in patients with early-stage endometrial cancer ( OR = 6.22, 95% CI 1.22-31.73, P = 0.028). The 3-year PFS rates for the whole group of patients with PPC and NPC were 72.9% and 92.7%, and the difference was statistically significant ( P = 0.001); the 3-year PFS rates for early-stage patients with PPC and NPC were 82.5% and 96.2%, and the difference was statistically significant ( P = 0.002). PPC was an independent risk factor for PFS in the whole group of patients with endometrial cancer ( HR = 4.80, 95% CI 1.14-20.17, P=0.032); PPC was also an independent risk factor for PFS in patients with early-stage endometrial cancer ( HR = 8.85, 95% CI 1.96-39.93, P = 0.005). Conclusions:Deep myometrial infiltration is an independent risk factor for PPC, and PPC is an independent risk factor for PFS in patients with endometrial cancer. Routine cytological examination of peritoneal fluid is recommended in patients with endometrial cancer.
ABSTRACT
Objective To analyze the correlation between the direct measurement of pulmonary artery pressure and the related echocardiographic parameters in rats with pulmonary arterial hypertension ( PA H ) , and establish a predictable equation for pulmonary artery pressure using non‐invasive ultrasonic parameters . Methods Fifteen male Wistar rats were randomly divided into normal control ( NC ) group with five rats and PA H model group with 10 rats .PA H model was established by intraperitoneal injection of 1% MCT solution in the dose of 60 mg/kg . All the rats were examined by ultrasonic apparatus to record cardiac parameters including right ventricle anterior wall thickness ( RVAWT ) ,pulmonary artery diameter ( PAD) , aorta diameter ( AOD ) , pulmonary artery acceleration time ( PAAT ) , pulmonary artery ejection time ( PAET ) ,right ventricle end‐diastolic diameter ( RVEDD ) ,right ventricle end‐diastolic length ( RVEDL ) , tricuspid annular plane systolic excursion ( T APSE) and left ventricular ejection fraction ( LVEF ) before experiments as well as 2 and 4 weeks after modeling . At the fifth week of modeling ,all the rats were administrated with thoracotomy and right ventricular catheter to obtain pulmonary artery systolic ,diastolic and mean pressures ( PASP ,PADP and PAM P) . Results As time went on ,measures of RVAWT ,PAD , PAD/AOD ,RVEDD ,RVEDL ,RVEDD/RVEDL increased ,while measurements of PAA T ,PAA T/PAET , T APSE decreased in the model group .T he changes of RVAWT ,PAD ,PAA T/PAET ,RVEDD in the model group appeared early in the second week in contrast to data before molding ( P ＜0 .05) . When comparing model group with NC group ,there were statistic differences of RVAWT ,PAAT/PAET as early as 2 weeks after modeling measuring (all P ＜0 .05) and the dramatic variance in the parameters of PAD/AOD ,PAAT , RVEDD ,RVEDD/RVEDL ,T APSE appeared in 4‐week observation . Correlation analysis suggested there were high‐degree correlations between PAA T ,PAA T/PAET and PASP ,PAM P ( for PASP : r ＝ －0 .829 ,－0 .865 ,P＜ 0 .05 ; for PAM P : r ＝ －0 .831 , －0 .842 , P ＜ 0 .05 ) ,and moderate‐degree correlations between RVAWT ,PAD/AOD ,RVEDD ,RVEDD/RVEDL ,T APSE and PASP ,PAM P ( for PASP :|r|＝0 .615－0 .786 , P ＜0 .05 ; for PAM P : r ＝0 .683－0 .799 , P ＜0 .05) .T he linear dependent equations were established as PASP ＝ －169 .392 PAAT/PAET + 105 .092 ( r2 ＝ 0 .748 , P ＝ 0 .000 ) ,PASP ＝ 49 .576 RVAWT+67 .314RVEDD/RVEDL －45 .198 ( r2 ＝0 .731 , P ＝0 .003) ,PAM P＝ －150 .664PAAT/PAET+88 .156 ( r2 ＝0 .709 , P ＝ 0 .001 ) ,PAM P＝37 .988RVAWT +82 .072RVEDD/RVEDL －50 .517 ( r2 ＝0 .794 , P ＝ 0 .001 ) to represent the relationships between PASP or PAM P and PAAT/PAET or RVAWTcombined RVEDD/RVEDL . Conclusions Echocardiography can monitor changes in heart structure and hemodynamics .Ultrasonic parameters especially PAAT/PAET or RVAWT ,RVEDD/RVEDL could be used to estimate PASP or PAM P measured by catheterization .