Prognostic significance of positive peritoneal cytology in adenocarcinoma of the uterine cervix.

OBJECTIVE

A retrospective analysis was carried out to evaluate the prognostic significance of peritoneal cytology in cervical adenocarcinoma.

METHODS

The records of 107 patients with FIGO stage IB to IIB cervical adenocarcinoma who underwent hysterectomy were reviewed.

RESULTS

Sixteen patients (15%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative cytology was 50% or 87%, respectively, showing a significant difference (log-rank, P<0.001). The recurrence-free survival (RFS) rate at 36 months in the cytology-positive or -negative group was 53% or 87%, respectively, the difference being significant (log-rank, P=<0.001). Cox model analysis revealed positive cytology [hazards ratio (HR) 6.27, 95% confidence interval (CI) 2.13-18.41], positive lymph node (HR 6.20, 95% CI 1.87-20.57), ovarian metastasis (HR 5.20, 95% CI 1.18-22.82), and histological grade (HR 5.97, 95% CI 2.00-17.78) to be independent adverse risk factors for survival among the factors analyzed (lymph node status, lymph-vascular space invasion, tumor size, depth in cervical wall, pathological parametrial involvement, infiltration to vagina, ovarian metastasis, and histological grade). Cox model analysis showed that positive cytology (HR 4.58, 95% CI 1.48-14.16), positive lymph node (HR 7.61, 95% CI 2.69-21.54), and histological grade (HR6.13, 95% CI 2.14-17.77) were independent adverse risk factors for RFS. The incidence of peritoneal spread at the first recurrence among the cytology-positive group (62.5%) was significantly higher than that among the cytology-negative group (12.5%) (Fisher's exact test, P=0.021).

CONCLUSION

The presence of positive peritoneal cytology appears to be an independent prognostic risk factor in patients with cervical adenocarcinoma.