术前诊断性宫腔镜检查对非子宫内膜样癌患者腹水细胞学结果及预后的影响

Effects of preoperative diagnostic hysteroscopy on peritoneal cytology and prognosis in patients with non-endometrioid carcinoma

目的探讨术前诊断性宫腔镜检查对非子宫内膜样癌患者腹水细胞学结果及预后的影响。方法收集2008年10月至2021年12月北京大学人民医院收治的97例行手术治疗且术后病理检查证实为非子宫内膜样癌(包括浆液性癌、透明细胞癌、混合型腺癌、未分化癌等)患者的临床病理资料进行回顾性分析。根据患者是否在术前进行宫腔镜直视下活检及分段诊刮术,分为宫腔镜组(44例)、非宫腔镜组(53例),分析两组患者腹水细胞学结果及预后的差异。结果(1)宫腔镜组Ⅰ~Ⅱ期患者的比例显著高于非宫腔镜组[分别为68%(30/44)、47%(25/53);χ^(2)=4.32,P=0.038];而两组患者的年龄、体重指数、肿瘤最大径、病理类型、治疗方式分别比较,差异均无统计学意义(P均>0.05)。(2)97例患者中,腹水细胞学阳性25例(26%,25/97);其中,宫腔镜组腹水细胞学阳性率为11%(5/44),低于非宫腔镜组的38%(20/53),两组比较,差异有统计学意义(χ^(2)=8.74,P=0.003)。根据手术病理分期进行分层,Ⅰ~Ⅱ期患者(55例)中宫腔镜组腹水细胞学阳性率(3%,1/30)低于非宫腔镜组(12%,3/25),Ⅲ~Ⅳ期患者(42例)中宫腔镜组腹水细胞学阳性率(4/14)也低于非宫腔镜组(61%,17/28),但两组分别比较,差异均无统计学意义(P均>0.05)。(3)宫腔镜组、非宫腔镜组患者的5年无病生存(DFS)率分别为72.7%、60.4%,两组比较,差异无统计学意义(P=0.186);根据手术病理分期进行分层,Ⅰ~Ⅱ期患者中宫腔镜组、非宫腔镜组5年DFS率分别为90.0%、72.0%(P=0.051),Ⅲ~Ⅳ期患者中宫腔镜组、非宫腔镜组5年DFS率分别为35.7%、50.0%(P=0.218),分别比较,差异均无统计学意义。宫腔镜组、非宫腔镜组患者的5年总生存(OS)率分别为86.4%、81.1%,两组比较,差异无统计学意义(P=0.388);根据手术病理分期进行分层,Ⅰ~Ⅱ期患者中宫腔镜组、非宫腔镜组5年OS率分别为93.3%、96.0%(P=0.872),Ⅲ~Ⅳ期患者中宫腔镜组、非宫腔镜组5年OS率分别为71.4%、67.9%(P=0.999),分别比较,差异均无统计学意义。结论术前宫腔镜检查并未增加手术时腹水细胞学阳性率,也不影响非子宫内膜样癌患者的预后,因此,在非子宫内膜样癌患者中进行术前宫腔镜直视下活检及分段诊刮术可能是安全的。

Objective To explore the effects of preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage on the risk of abdominal dissemination and prognosis of non-endometrioid carcinoma.Methods The clinical and pathological data of 97 patients who underwent surgical treatment and were pathologically confirmed as non-endometrioid carcinoma(including serous carcinoma,clear cell carcinoma,mixed adenocarcinoma,and undifferentiated carcinoma,etc.)from October 2008 to December 2021 in Peking University People's Hospital,were collected for retrospective analysis.According to preoperative diagnostic methods,they were divided into hysteroscopic group(n=44)and non-hysteroscopic group(n=53).The impact of hysteroscopy examination on peritoneal cytology and prognosis was analyzed.Results(1)There were no statistical differences in age,body mass index,tumor size,pathological characteristics,and treatment methods between the hysteroscopic group and the non-hysteroscopic group(all P>0.05),but the proportion of stage Ⅰ-Ⅱ patients in the hysteroscopic group was significantly higher than that in the non-hysteroscopic group[68%(30/44)vs 47%(25/53);χ^(2)=4.32,P=0.038].(2)Among 97 patients,25(26%,25/97)of them were cytologically positive for ascites.The hysteroscopic group had a lower positive rate of peritoneal cytology than that in the non-hysteroscopy group,which was significantly different[11%(5/44)vs 38%(20/53);χ^(2)=8.74,P=0.003].Stratification according to surgical and pathological stages showed that the positive rate of peritoneal cytology in the hysteroscopic group(3%,1/30)was lower than that in the non-hysteroscopic group(12%,3/25)in the 55 patients with stage Ⅰ-Ⅱ,and that in the hysteroscopic group(4/14)was also lower than that in the non-hysteroscopic group(61%,17/28)in the 42 patients with stage Ⅲ-Ⅳ.There were no significant differences(all P>0.05).(3)The 5-year disease-free survival(DFS)rate of the hysteroscopic group and the non-hysteroscopic group were respectively 72.7% and 60.4%,and there was no significant difference between the two groups(P=0.186).After stratification according to staging,the 5-year DFS rate were respectively 90.0% and 72.0%(P=0.051)between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅰ-Ⅱ,and 35.7% and 50.0%(P=0.218)between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅲ-Ⅳ,in which there were not statistically significant differences.The 5-year overall survival(OS)rate were respectively 86.4% and 81.1% between the hysteroscopic group and the non-hysteroscopic group,with no significant difference between the two groups(P=0.388).The 5-year OS rate were respectively 93.3% and 96.0% in the hysteroscopic group and non-hysteroscopic group for patients with stageⅠ-Ⅱ(P=0.872),and 71.4%and 67.9% in the hysteroscopic group and non-hysteroscopic group in patients with stage Ⅲ-Ⅳ(P=0.999),with no statistical significance.Conclusions Diagnostic hysteroscopy do not increase the rate of positive peritoneal cytology result at the time of surgery in this cohort,and no significant correlation between preoperative hysteroscopy examination and poor prognosis of non-endometrioid carcinoma is observed.Therefore,preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage in non-endometrioid carcinoma maybe safe.