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Rewinding the clock on positive peritoneal cytology in endometrial cancer: does it predict prognosis in low-risk

Diletta Fumagalli1, Emilia Palmieri2, Giuseppe Caruso1

  • 1Mayo Clinic, Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Rochester, MN, USA; European Institute of Oncology (IEO) IRCCS, Department of Gynecology, Milan, Italy.

International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society
|April 29, 2025
PubMed
Summary
This summary is machine-generated.

Positive peritoneal cytology in low-risk endometrial cancer predicts recurrence, impacting recurrence-free survival but not overall survival. This finding is crucial for understanding endometrial cancer prognosis and treatment strategies.

Keywords:
CytologyEndometrial CancerGynecologic NeoplasmsGynecologic SurgeryPeritoneal Washing

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Area of Science:

  • Gynecologic Oncology
  • Surgical Pathology
  • Cancer Prognostics

Background:

  • Positive peritoneal cytology in endometrial cancer is a known adverse prognostic factor.
  • Its specific impact on low-risk patients and its role in guiding treatment remain unclear.
  • Current staging and adjuvant treatment guidelines do not incorporate peritoneal cytology findings.

Purpose of the Study:

  • To investigate the prognostic significance of positive peritoneal cytology in endometrial cancer, with a specific focus on low-risk disease.
  • To evaluate the association between positive peritoneal cytology and oncologic outcomes, particularly recurrence, in low-risk endometrial cancer patients.
  • To determine if positive peritoneal cytology independently predicts recurrence in low-risk endometrial cancer.

Main Methods:

  • Retrospective cohort study of 3517 patients undergoing primary surgery for endometrial cancer (1999-2021).
  • Analysis of two low-risk subgroups based on National Comprehensive Cancer Network (NCCN) and European Society of Gynecologic Oncology/European Society of Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) guidelines.
  • Univariate, multivariable, and Kaplan-Meier survival analyses to assess the association of peritoneal cytology with 5-year recurrence-free and overall survival.

Main Results:

  • Positive peritoneal cytology was detected in 8.1% (NCCN low-risk) and 7.9% (ESGO/ESTRO/ESP low-risk) of patients.
  • Patients with positive peritoneal cytology in both low-risk groups exhibited significantly worse 5-year recurrence-free survival (p < .01 and p = .03).
  • Positive peritoneal cytology remained an independent predictor of recurrence after multivariable analysis in both low-risk subgroups.

Conclusions:

  • Positive peritoneal cytology is an independent predictor of recurrence in low-risk endometrial cancer.
  • It is associated with worse recurrence-free survival but does not impact overall survival in this patient group.
  • These findings suggest peritoneal cytology may refine risk stratification for low-risk endometrial cancer.