Significance of Malignant Peritoneal Cytology on the Survival of Women with Early-Stage Cervical Cancer: A Japanese Gynecologic Oncology Group Study

• Main Authors: Koji Matsuo, Muneaki Shimada, Shinya Matsuzaki, Hiroko Machida, Yoshikazu Nagase, Toshiaki Saito, Shoji Kamiura, Takashi Iwata, Toru Sugiyama, Mikio Mikami
• Format: Article
• Language: English
• Published: MDPI AG 2019-11-01
• Series: Journal of Clinical Medicine
• Subjects: cervical cancer; radical hysterectomy; peritoneal cytology: malignant cytology; adjuvant therapy; chemotherapy; survival
• Online Access: https://www.mdpi.com/2077-0383/8/11/1822

This study examined the association between peritoneal cytology and survival in early-stage cervical cancer. This is a nationwide multicenter retrospective study, examining consecutive women with clinical stage IB1-IIB cervical cancer who underwent radical hysterectomy with available peritoneal cytology results from 2004−2008. Propensity score inverse probability of treatment weighting was used to assess the impact of malignant peritoneal cytology on survival. Among 1409 analyzed cases, 88 (6.2%) had malignant peritoneal cytology. On weighted models, malignant peritoneal cytology was associated with decreased disease-free survival (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.36−2.32) and overall survival (OS, HR 1.93, 95% CI 1.44−2.59). On sensitivity analyses, malignant peritoneal cytology was associated with decreased OS in adenocarcinoma/adenosquamous carcinoma, high-risk early-stage disease and those who received concurrent chemo-radiotherapy. However, among women who received postoperative systemic chemotherapy, malignant peritoneal cytology was not associated with OS (HR 1.21, 95% CI 0.72−2.04). A systematic review, including our results, showed that malignant peritoneal cytology was associated with decreased OS (HR 4.03, 95% CI 1.81−8.99) and increased recurrence in squamous carcinoma (odds ratio 1.89, 95% CI 1.05−3.39) and adenocarcinoma (odds ratio 4.30, 95% CI 2.30−8.02). In conclusion, the presence of malignant cells in peritoneal cytology is associated with decreased survival in early-stage cervical cancer. The possible benefit of systemic chemotherapy in this subgroup merits further investigation.