TITLE:
Is Peritoneal Cytology a Prognostic Factor in Endometrial Cancer?
AUTHORS:
Jonathan Foote, William T. Creasman
KEYWORDS:
Endometrial Cancer, FIGO Staging, Peritoneal Cytology, Prognosis, Peritoneal Washings
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.8,
July
28,
2015
ABSTRACT: The International Federation of Gynecology and
Obstetrics (FIGO) changed the surgical staging criteria for endometrial cancer
in 2009, namely combining FIGO 1988 Stage IA and IB in FIGO 2009 Stage IA,
eliminating cervical glandular involvement from Stage II, and removing
peritoneal cytology as criteria from Stage IIIA (3). This review of the
literature sheds light on the continued debate among authorities on the utility
of peritoneal cytology in surgical staging of endometrial cancer. At the time FIGO
removed peritoneal cytology from the staging criteria in 2009, there was little
to no evidence to support its removal. In fact, FIGO continues to recommend
obtaining peritoneal cytology, which is in contradiction to their staging
criteria. While a few small studies support the idea that peritoneal cytology
does not preclude a worse prognosis, a number of large scale studies with at
least 300 patients demonstrate a clear association between survival and the
presence of malignant peritoneal cytology (11 - 12, 15 - 19). In one of the
largest studies, investigators reviewed 14,704 from the SEER’s database,
demonstrating that malignant peritoneal cytology is associated with decreased
survival across Stage I/II disease even when controlled for histology, grade,
and other risk factors. Malignant peritoneal cytology should be considered when
counseling patients on the risk of recurrence and overall survival of
endometrial cancer. However, the role of adjuvant treatment in this setting
remains unclear.