子宫内膜癌患者腹腔积液细胞学阳性的影响因素及其与预后关系的研究

Study on influencing factors of positive peritoneal cytology and its relationship with prognosis in patients with endometrial cancer

目的探讨子宫内膜癌患者腹腔积液细胞学阳性(PPC)的危险因素及PPC对患者预后的影响。方法回顾性分析2015年1月至2019年12月于山东大学齐鲁医院初次接受手术治疗且术后病理诊断为子宫内膜癌的202例患者的临床病理资料,均于术中送检腹腔积液进行细胞学液基涂片检查。采用logistic回归对全组患者和其中的早期患者PPC进行单因素及多因素分析;采用Kaplan-Meier法对全组患者及早期患者无进展生存进行单因素分析,比较采用log-rank检验,采用Cox比例风险模型对全组患者及早期患者无进展生存进行多因素分析。结果202例患者中,183例(90.6%)腹腔积液细胞学阴性(NPC),19例(9.4%)PPC;Ⅰ~Ⅱ期患者180例(89.1%),Ⅲ~Ⅳ期患者22例(10.9%);早期子宫内膜癌患者180例(89.1%)。深肌层浸润(OR=3.57,95%CI 1.02~12.45,P=0.046)、淋巴结转移(OR=7.16,95%CI 1.70~30.23,P=0.007)是子宫内膜癌患者PPC的独立危险因素;深肌层浸润是早期子宫内膜癌患者PPC的独立危险因素(OR=6.22,95%CI 1.22~31.73,P=0.028)。全组中PPC和NPC患者的3年PFS率分别为72.9%和92.7%,差异有统计学意义(P=0.001);早期PPC和NPC患者的3年PFS率分别为82.5%和96.2%,差异有统计学意义(P=0.002)。PPC是全组子宫内膜癌患者PFS的独立危险因素(HR=4.80,95%CI 1.14~20.17,P=0.032),PPC也是早期子宫内膜癌患者PFS的独立危险因素(HR=8.85,95%CI 1.96~39.93,P=0.005)。结论深肌层浸润是PPC的独立危险因素,PPC是子宫内膜癌患者PFS的独立危险因素。建议子宫内膜癌患者常规行腹腔积液细胞学检查。

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 stageⅠ-Ⅱand 22(10.9%)were stageⅢ-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.