Progress in gastric cancer with positive peritoneal cytology / 中华胃肠外科杂志

Gastric cancer with positive peritoneal cytology is a hotspot in the study of gastric cancer, and its prognosis is poor. Intraperitoneal free cancer cells may be associated with cancer cells migration, invasion and metastasis. Tumor T stage, peritoneal metastasis, lymph node metastasis, low histological differentiation, linitis plastica, adenocarcinoma of esophagogastric junction, and operation are the clinicopathological risk factors of gastric cancer with positive peritoneal cytology. Currently, the acquisition of free cancer cells is mainly through diagnostic laparoscopy combined with peritoneal lavage, and cytopathological examination is gold standard for diagnosis. Its treatment strategies are not in consensus, including preoperative chemotherapy combined with radical resection, postoperative chemotherapy and peritoneal local treatment, which can prolong the survival of patients. At present, postoperative chemotherapy is often used in China, and the best treatment strategies remain to be further studied.

Risk factors and prognosticsignificance of positive peritoneal cytology in endometrial cancer / 基础医学与临床

Objective To determine the prognostic significance of positive peritoneal cytology (PPC) among patients with endometrial cancer and to find out potential risk factors for PPC in endometrial cancer.Methods Data were extracted from Peking Union Medical College Hospital between Jan 1 2005 and Dec 31 2010.Only those patients who had undergone a staging procedure were included.A total of 486 patients were identified.Statistical analyses were performed using Fisher`s exact test, Kaplan-Meier log rank, and Cox proportional hazards models.ResultsRate of PPC was 4.8% in endometrial cancer.Non-endometrioid endometrial cancer(P=0.000), stage Ⅲ/Ⅳ(P=0.000), deep myometrial invasion(P=0.001), and cervical stromal involvement(P=0.018) appeared to be risk factors for PPC in endometrial cancer.Univariate analysis revealed statistically difference in 5-year PFS (70.9% vs 90.0%) and 5-year OS (72.2% vs 96.0%).Progression-free survival and overall survival showedstatistically difference(P=0.005,P=0.000)between PPC and NPC endometrial cancer.On multivariate analysis, PPC remained no statistically difference in progression-free survival or overall survival(RR=3.812,95% CI 0.897-16.200,P=0.070;RR=3.426,95% CI 0.800-14.673,P=0.097).Conclusions PPC is not an independent risk factor in patients with endometrial cancer.Aggressive histology, FIGO stage, deep myometrial invasion and cervical stromal involvement are presumed to be associated with PPC in endometrial cancer.

Influence of two kinds of preoperative examinations methods on detection rate of peritoneal cytology and the survival rate of patients with endometrial carcinoma / 中国内镜杂志

Objective To investigate the influence of curettage of uterine cavity and hysteroscopy detection before operation on detection rate of abdominal cavity and the survival rate of patients with endometrial carcinoma. Methods 120 patients with endometrial carcinoma were chosen in the period from March 2011 to December 2013 were divided into 2 groups including curettage of uterine cavity group (64 patients) with curettage of uterine cavity and hysteroscopy group (56 patients) with hysteroscopy detection according to preoperative examinations methods; and the eligible rate of specimens, the concordance rate of pathological diagnosis, the detection rate of peritoneal cytology, the overall survival rate and progression free survival rate in 3 years with follow-up of both groups were compared. Results There was no significant difference in the eligible rate of specimens and the concordance rate of pathological diagnosis between the two groups (P > 0.05). The detection rate of ascites cytology of hysteroscopy group were significantly higher than curettage of uterine cavity group (P < 0.05). There was no significant difference in the overall survival rate and progression free survival rate in 3 years with follow-up between the two groups (P > 0.05). Conclusion Curettage of uterine cavity and hysteroscopy detection before operation on patients with endometrial carcinoma posses the same diagnosis value; And hysteroscopy detection maybe peritoneal metastasis risk, but have no effect on long-term survival and larger randomized controlled trials should be necessary.

Influence of two kinds of preoperative examinations methods on detection rate of peritoneal cytology and the survival rate of patients with endometrial carcinoma / 中国内镜杂志

Objective To investigate the influence of curettage of uterine cavity and hysteroscopy detection before operation on detection rate of abdominal cavity and the survival rate of patients with endometrial carcinoma. Methods 120 patients with endometrial carcinoma were chosen in the period from March 2011 to December 2013 were divided into 2 groups including curettage of uterine cavity group (64 patients) with curettage of uterine cavity and hysteroscopy group (56 patients) with hysteroscopy detection according to preoperative examinations methods; and the eligible rate of specimens, the concordance rate of pathological diagnosis, the detection rate of peritoneal cytology, the overall survival rate and progression free survival rate in 3 years with follow-up of both groups were compared. Results There was no significant difference in the eligible rate of specimens and the concordance rate of pathological diagnosis between the two groups (P > 0.05). The detection rate of ascites cytology of hysteroscopy group were significantly higher than curettage of uterine cavity group (P < 0.05). There was no significant difference in the overall survival rate and progression free survival rate in 3 years with follow-up between the two groups (P > 0.05). Conclusion Curettage of uterine cavity and hysteroscopy detection before operation on patients with endometrial carcinoma posses the same diagnosis value; And hysteroscopy detection maybe peritoneal metastasis risk, but have no effect on long-term survival and larger randomized controlled trials should be necessary.

The impact of combined radiation and chemotherapy on outcome in uterine papillary serous carcinoma compared to chemotherapy alone / 부인종양

OBJECTIVE: To investigate the impact of pelvic radiation on survival in patients with uterine serous carcinoma (USC) who received adjuvant chemotherapy. METHODS: Patients with stage I-IV USC were identified from the Surveillance, Epidemiology, and End Results program 2000 to 2009. Patients were included if treated with surgery and chemotherapy. Patients were divided into two groups: those who received chemotherapy and pelvic radiation therapy (CT_RT) and those who received chemotherapy only (CT). Kaplan-Meier curves and Cox regression proportional hazard models were used. RESULTS: Of the 1,838 included patients, 1,272 (69%) were CT and 566 (31%) were CT_RT. Adjuvant radiation was associated with significant improvement in overall survival (OS; p<0.001) and disease-specific survival (DSS; p<0.001) for entire cohort. These findings were consistent for the impact of radiation on OS (p<0.001) and DSS (p<0.001) in advanced stage (III-IV) disease but not for early stage (I-II) disease (p=0.21 for OS and p=0.82 for DSS). In multivariable analysis adjusting for age, stage, race and extent of lymphadenectomy, adjuvant radiation was a significant predictor of OS and DSS for entire cohort (p=0.003 and p=0.05) and in subset of patients with stage III (p=0.02 and p=0.07) but not for patients with stage I (p=0.59 and p=0.49), II (p=0.83 and p=0.82), and IV USC (p=0.50 and p=0.96). Other predictors were stage, positive cytology, African American race and extent of lymphadenectomy. CONCLUSION: In USC patients who received adjuvant chemotherapy, adjuvant radiation was associated with significantly improved outcome in stage III disease but not for other stages. Positive cytology, extent of lymphadenectomy and African race were significant predictors of outcome.

The relationship between positive peritoneal cytology and the prognosis of patients with FIGO stage I/II uterine cervical cancer / 부인종양

OBJECTIVE: The purpose of this study was to assess whether peritoneal cytology has prognostic significance in uterine cervical cancer. METHODS: Peritoneal cytology was obtained in 228 patients with carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics [FIGO] stages IB1-IIB) between October 2002 and August 2010. All patients were negative for intraperitoneal disease at the time of their radical hysterectomy. The pathological features and clinical prognosis of cases of positive peritoneal cytology were examined retrospectively. RESULTS: Peritoneal cytology was positive in 9 patients (3.9%). Of these patients, 3/139 (2.2%) had squamous cell carcinoma and 6/89 (6.7%) had adenocarcinoma or adenosquamous carcinoma. One of the 3 patients with squamous cell carcinoma who had positive cytology had a recurrence at the vaginal stump 21 months after radical hysterectomy. All of the 6 patients with adenocarcinoma or adenosquamous carcinoma had disease recurrence during the follow-up period: 3 with peritoneal dissemination and 2 with lymph node metastases. There were significant differences in recurrence-free survival and overall survival between the peritoneal cytology-negative and cytology-positive groups (log-rank p<0.001). Multivariate analysis of prognosis in cervical cancer revealed that peritoneal cytology (p=0.029) and histological type (p=0.004) were independent prognostic factors. CONCLUSION: Positive peritoneal cytology may be associated with a poor prognosis in adenocarcinoma or adenosquamous carcinoma of the uterine cervix. Therefore, the results of peritoneal cytology must be considered in postoperative treatment planning.

Analysis of Prognosis in Colorectal Mucinous Adenocarcinoma: A Retrospective Analysis with Peritoneal Fluid

PURPOSE: Although many papers have reported poor prognosis of colorectal mucinous adenocarcinoma, the underlying cause for its unfavorable outcome is yet to be elucidated. In the peritoneal fluid studies, we observed that peritoneal recurrences and cytology positive cases were many times mucinous cancers. On the basis of these observations, mucinous and non-mucinous adenocarcinomas were compared and prognostic factors were studied. METHODS: Five hundred and forty-six patients who underwent surgery for colorectal adenocarcinomas from January 2004 to December 2008 were included. RESULTS: Among the 546 patients, mucinous adenocarcinomas were 30 (5.5%) and non-mucinous adenocarcinomas were 516 (94.5%). Mean age was 55.0 years, which was younger than 63.2 years in non-mucinous colon cancers. They tend to develop in the right colon. Mucinous adenocarcinomas were more advanced in depth of invasion and distant metastasis, but no significant difference in lymph node (LN) metastasis. Peritoneal CEA, CA19-9, and positive cytology were more apparent. Liver and peritoneal metastasis did not show significant increases. Five year survival rates were 82.9% and 91.7% and cancer free survival rates were 42.7% and 68.5% each, respectively, for mucinous and non-mucinous cancers. According to stage, only stage III and IV patients showed differences in cancer free survival and overall survival (P=0.001, 0.040). CONCLUSION: Mucinous adenocarcinomas showed worse prognoses and significant differences in recurrences, but had similar prognoses in early cancers. Although no significant differences were in LN metastasis, dissimilarities were in infiltration depth. Infiltrations led to the increase in free cancer cells and peritoneal fluid tumor markers: ultimately cancer recurrences developed.

Impact of Hysteroscopy on Peritoneal Cytology in Patients with Endometrial Carcinoma / 中国微创外科杂志

Objective To explore the accuracy of hysteroscopy as a diagnosis for endometrial carcinoma and to determine if the procedure increase the rate of positive peritoneal cytology in the patients. Methods The peritoneal cytology of 36 patients with endometrial carcinoma diagnosed by D&C or hysteroscopy was retrospectively analyzed. Results The peritoneal cytology was positive in 1 (5.9%) of the 17 cases diagnosed by D&C and 2 (10.5%) of the 19 cases diagnosed by hysteroscopy (P=1.000). Based on the pathological examination,the accuracy of D&C was 52.9% (9/17),which was significantly lower than that of hysteroscopy [89.5% (17/19),P=0.025]. In the cases with stage Ⅰ endometrial carcinoma,the diagnostic accordance rate of hysteroscopy was 85.7% (12/14),while that of the D&C was 42.9% (6/14,P=0.040). The 36 patients were followed up for 2 months to 4 and a half year (over 1 year in 28 cases). One patient with Ⅲc stage carcinoma died of recurrent tumor in 2 years after the treatment. Conclusion Hysteroscopy shows higher diagnosis accuracy with no evidence indicating an increased rate of positive peritoneal cytology compared to D&C.

Effect of diagnostic hysteroscopy on peritoneal cytology and prognosis in patients with clinical stage one endometrial cancer / 重庆医科大学学报

Objective: To explore the safety of using diagnostic hysteroscopy in patients with clinical stage one endometrial cancer,whether diagnostic hysteroscopy can increases the risk of positive peritoneal cytology in such patients and affects their post-operative prognosis.Methods: Medical records of 52 patients with clinical stage one endometrial cancer diagnosed by pre-operative hysteroscopy in our hospital were reviewed in this retrospective study,informations about cytological test of abdominal peritoneal fluid,type of operation,post-operative surgical stage and follow-up were collected.Results: The mean interval between hysteroscopy and laparotomy was 36 days(5~82d),2/52(3.8%) present positive peritoneal cytology,the mean survival time was 81 months(9~130m),the 5-year survival rate was 91.5%.Conclusion: Diagnostic hysteroscopy had not increase the risk of positive peritoneal cytology,also had no adverse effect on prognosis in clinical stage one endometrial cancer patients.