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Sugarbaker PH, Deng T. Phase 1 trial of same day cytology to guide the use of HIPEC. Int J Surg Protoc 2024; 28:6-11. [PMID: 38433868 PMCID: PMC10905492 DOI: 10.1097/sp9.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/20/2023] [Indexed: 03/05/2024] Open
Abstract
Background Peritoneal metastases from gastrointestinal or gynecologic malignancy are a prominent part of the natural history of these diseases. Peritoneal metastases, if not effectively treated, will result in a decreased survival and cause an impaired quality of life. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment specifically designed to combat peritoneal metastases. A group of patients who, from a theoretical perspective, may benefit from HIPEC are those patients with a positive peritoneal cytology. In order to identify these patients at the time of a surgical intervention, a same day cytology is to be performed. Materials and methods The result of this test is to be available at or before the completion of the cancer resection. If the cytology is positive, the patient immediately becomes a candidate for HIPEC. The HIPEC will be of maximal value if a complete cytoreduction, as judged by the surgeon, has been possible. This phase 1 trial is to demonstrate that the Surgical Oncology Service, the Department of Pathology, the Pharmacy and the Operating Room personnel can co-ordinate a phase 1 protocol to successfully complete the same day cytology with an efficient delivery of HIPEC. A standardized plan for consent, cytology collection, preparation of the specimen, reading of the specimen, reporting the results in a timely manner facilitates the administration of HIPEC in peritoneal cytology positive patients. Dissemination Successful completion of these requirements is a positive result for this study and allows for future protocols to be generated. Successful completion of the same day cytology phase 1 protocol will allow the efficacy, safety, and efficiency of this plan of patient management to be evaluated.
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Affiliation(s)
| | - Tom Deng
- Department of Pathology, MedStar Washington Hospital Center, Washington, DC, USA
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Zorzato PC, Uccella S, Biancotto G, Bosco M, Festi A, Franchi M, Garzon S. Intrauterine manipulator during hysterectomy for endometrial cancer: a systematic review and meta-analysis of oncologic outcomes. Am J Obstet Gynecol 2024; 230:185-198.e4. [PMID: 37704174 DOI: 10.1016/j.ajog.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE This study aimed to assess the effects on oncologic outcomes of intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer. DATA SOURCES A systematic literature search was performed by an expert librarian in multiple electronic databases from inception to January 31, 2023. STUDY ELIGIBILITY CRITERIA We included all studies in the English language that compared oncologic outcomes (recurrence-free, cause-specific, or overall survival) between endometrial cancer patients who underwent total laparoscopic or robotic hysterectomy for endometrial cancer with vs without the use of an intrauterine manipulator. Studies comparing only peritoneal cytology status or lymphovascular space invasion were summarized for completeness. No selection criteria were applied to the study design. METHODS Four reviewers independently reviewed studies for inclusion, assessed their risk of bias, and extracted data. Pooled hazard ratios with 95% confidence intervals were estimated for oncologic outcomes using the random effect model. Heterogeneity was quantified using the I2 tests. Publication bias was assessed by funnel plot and Egger test. RESULTS Out of 350 identified references, we included 2 randomized controlled trials and 12 observational studies for a total of 14 studies and 5,019 patients. The use of an intrauterine manipulator during hysterectomy for endometrial cancer was associated with a pooled hazard ratio for recurrence of 1.52 (95% confidence interval, 0.99-2.33; P=.05; I2=31%; chi square P value=.22). Pooled hazard ratio for recurrence was 1.48 (95% confidence interval, 0.25-8.76; P=.62; I2=67%; chi square P value=.08) when only randomized controlled trials were considered. Pooled hazard ratio for overall survival was 1.07 (95% confidence interval, 0.65-1.76; P=0.79; I2=44%; chi square P value=.17). The rate of positive peritoneal cytology or lymphovascular space invasion did not differ using an intrauterine manipulator. CONCLUSION Intrauterine manipulator use during hysterectomy for endometrial cancer was neither significantly associated with recurrence-free and overall survival nor with positive peritoneal cytology or lymphovascular space invasion, but further prospective studies are needed.
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Affiliation(s)
- Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy.
| | - Giulia Biancotto
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Anna Festi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
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Shindo Y, Tokumitsu Y, Matsui H, Nakajima M, Kimura Y, Iida M, Suzuki N, Takeda S, Ioka T, Nagano H. Efficacy of Staging Laparoscopy in Patients With Pancreatic Cancer: A Single Center Prospective Cohort Study. In Vivo 2023; 37:2704-2709. [PMID: 37905607 PMCID: PMC10621419 DOI: 10.21873/invivo.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM Staging laparoscopy (SL) for pancreatic cancer (PC) is considered useful to improve accuracy of staging and resectability. However, given the current accuracy of preoperative imaging, the routine application of SL remains unclear. Therefore, we aimed to investigate the importance of SL in patients with PC without radiological distant metastasis. PATIENTS AND METHODS This was a prospective, cohort, observational study. SL was performed in all patients with PC without radiological distant metastasis before pancreatectomy or chemotherapy at the Yamaguchi University Hospital. RESULTS Between July 2020 and March 2023, 55 patients underwent SL with peritoneal cytology. The median age was 71, with 53% male patients. SL revealed occult metastasis in six (11%) patients including positive peritoneal cytology (n=6), and peritoneal dissemination (n=1). The resectability of unresectable locally advanced (UR-LA) was associated with a significantly increased risk of occult metastasis (p=0.0211). The median operative time was 40 min, and the median volume of blood loss was 3 ml. There were no severe complications (Clavien-Dindo III or higher). CONCLUSION SL with peritoneal cytology regardless of previous abdominal surgery is safe and effective to determine accurate staging. Therefore, SL with peritoneal cytology should be considered for patients with PC without radiological distant metastasis, especially in those with UR-LA.
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Affiliation(s)
- Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroto Matsui
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masao Nakajima
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yuta Kimura
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Michihisa Iida
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Nobuaki Suzuki
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tatsuya Ioka
- Department of Oncology Center, Yamaguchi University Hospital, Ube, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan;
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Schena CA, Laterza V, De Sio D, Quero G, Fiorillo C, Gunawardena G, Strippoli A, Tondolo V, de'Angelis N, Alfieri S, Rosa F. The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives. Cancers (Basel) 2023; 15:3425. [PMID: 37444535 DOI: 10.3390/cancers15133425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
A significant proportion of patients diagnosed with gastric cancer is discovered with peritoneal metastases at laparotomy. Despite the continuous improvement in the performance of radiological imaging, the preoperative recognition of such an advanced disease is still challenging during the diagnostic work-up, since the sensitivity of CT scans to peritoneal carcinomatosis is not always adequate. Staging laparoscopy offers the chance to significantly increase the rate of promptly diagnosed peritoneal metastases, thus reducing the number of unnecessary laparotomies and modifying the initial treatment strategy of gastric cancer. The aim of this review was to provide a comprehensive summary of the current literature regarding the role of staging laparoscopy in the management of gastric cancer. Indications, techniques, accuracy, advantages, and limitations of staging laparoscopy and peritoneal cytology were discussed. Furthermore, a focus on current evidence regarding the application of artificial intelligence and image-guided surgery in staging laparoscopy was included in order to provide a picture of the future perspectives of this technique and its integration with modern tools in the preoperative management of gastric cancer.
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Affiliation(s)
- Carlo Alberto Schena
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Davide De Sio
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gayani Gunawardena
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenzo Tondolo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fausto Rosa
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Hashmi AA, Rashid K, Asif MG, Dowlah TU, Ali AH, Malik UA, Ali SM, Ali SJ, Zia S, Irfan M. Clinicopathological Parameters Associated With Peritoneal Involvement in Epithelial Ovarian Tumors. Cureus 2023; 15:e36666. [PMID: 37102035 PMCID: PMC10124578 DOI: 10.7759/cureus.36666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Ovarian tumors remain one of the leading malignancies of the female genital tract, with a high mortality rate due to their insidious onset and lack of detection at an earlier stage. These tumors metastasize by direct extension into the neighboring pelvic organs; hence, the detection of peritoneal metastasis is valuable for staging and prognostic purposes. Peritoneal wash cytological analysis is an effective predictor of the involvement of the ovarian surface and peritoneal dissemination even in subclinical involvement of the peritoneum. The study aims to determine the significance of peritoneal wash cytology as a prognostic parameter and correlate it with various clinicohistological features. Methods A retrospective study was conducted at the Department of Histopathology, Liaquat National Hospital, Karachi, Pakistan, between July 2017 and June 2022. During this period, all the cases of ovarian tumors (borderline and malignant) that underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omental and lymph node sampling were included in the study. After opening the abdominal cavity, the free fluid present was aspirated immediately, the peritoneum was lavaged with 50-100 mL of warm saline, and samples were collected and sent for cytological analysis. Four cytospin smear slides and cell block preparation were prepared. The findings of peritoneal cytology were correlated with various clinicohistological features. Results A total of 118 cases of ovarian tumors were included in the study. Serous carcinoma was the most common sub-type (50.8%), followed by endometrioid carcinoma (14.4%), and the mean age at diagnosis was found to be 49.9±14.9 years. The mean tumor size was 11.2 cm. The majority of the cases of ovarian carcinoma were of high grade (78.8%), with capsular invasion present in 61% of cases. Positive peritoneal cytology was noted in 58.5% of cases, with omental involvement in 52.5% of cases. Serous carcinoma showed the highest frequency of positive cytology (69.6%) and omental metastasis (74.2%). Apart from tumor type, positive peritoneal cytology showed a significantly positive correlation with age, tumor grade, and capsular invasion. Conclusion Based on our study findings, we conclude that peritoneal wash cytology is a sensitive indicator of the peritoneal spread of ovarian carcinoma, with a significant prognostic value. Serous carcinomas, especially high-grade with capsular invasion, were found to be predictors of peritoneal involvement of ovarian tumors. Although we found smaller tumors to be associated with peritoneal disease more compared to larger ones, this most likely is attributed to tumor histology, as larger tumors were most commonly mucinous compared to serous carcinomas.
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Affiliation(s)
- Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Khushbakht Rashid
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | - Abrahim H Ali
- Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | | | - Syed Munqaad Ali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Shamail Zia
- Pathology, Jinnah Sindh Medical University, Karachi, PAK
| | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
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Yang J, Yang J, Cao D, Wu M, Xiang Y. Prognostic Value of Peritoneal Cytology in Stage I Serous and Clear Cell Carcinoma of the Endometrium. J Clin Med 2023; 12. [PMID: 36836143 DOI: 10.3390/jcm12041609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
(1) Background: To investigate the relation between malignant peritoneal cytology and survival outcomes in patients who underwent primary staging surgery for stage I uterine serous (USC) or clear cell carcinoma (UCCC). (2) Methods: In this retrospective analysis, patients with stage I USC or UCCC who underwent staging surgery between 2010 and 2020 at the Peking Union Medical College Hospital were identified and reviewed. (3) Results: A total of 101 patients were included, and 11 patients had malignant cytology (10.9%). The median follow-up time was 44 months (range 6-120) with a total of 11 (10.9%) recurrences. Patients with malignant cytology had a higher likelihood of peritoneal recurrence and a shorter time to relapse (13 vs. 38 months, p = 0.022), as compared to patients with negative cytology. In univariate analysis, malignant cytology and serous histology had worse progression-free survival (PFS) and overall survival (OS) (all, p < 0.05). In sensitive analysis, the detrimental effects of malignant cytology on survival were more prominent in patients over 60 years old, those with serous histology, stage IB disease, and those who received hysteroscopy as a diagnostic test. (4) Conclusions: Stage I USC or UCCC patients with malignant peritoneal cytology had a higher recurrence and inferior survival.
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Liu S, Zhen L, Zhang S, Cai Y, Lin Y, Chen F, Li X, You Q, Lai X, Lai H, Zheng X, Yi H. Comparison of prognosis of patients with endometrial cancer after hysteroscopy versus dilatation and curettage: A multicenter retrospective study. Front Med (Lausanne) 2023; 9:1097133. [PMID: 36698830 PMCID: PMC9868660 DOI: 10.3389/fmed.2022.1097133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Hysteroscopy is a useful procedure for diagnosing endometrial cancer. There is controversy regarding whether hysteroscopy affects the prognosis of endometrial cancer by prompting cancer cell into intraperitoneal dissemination. Our purpose was to confirm whether hysteroscopy could be a risk factor of the tumor stage, recurrence and survival rate of endometrial cancer. Methods This multicenter retrospective study included all consecutive patients who had endometrial carcinoma diagnosed preoperatively with hysteroscopy and directed endometrial biopsy (HSC, group A) and dilatation and curettage (D&C, group B) between February 2014 and December 2018 at the Fujian Provincial, China. We compared the demographic feature, clinical characteristics and prognosis between the two groups. Results A total of 429 patients were included in the study (Group A, n = 77; Group B, n = 352). There was no significant difference between their baseline characteristics [including age, BMI, histological type and International Federation of Gynecology and Obstetrics (FIGO) stage]. By comparing several pathological conditions that may affect prognosis, there were no significant differences between the two groups in the peritoneal cytology, depth of myometrial invasion, the positivity of lymph nodes, lymphovascular space invasion and paraaortic lymph node dissection. Finally, no significant difference was found between the two groups in overall survival (OS) (P = 0.189) or recurrence free survival (RFS) (P = 0.787). Conclusion Under certain inflation pressure and distension medium, hysteroscopic examination and lesion biopsy ensure the safety and have no adverse effects on prognosis compared to conventional curettage.
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Affiliation(s)
- Shihuang Liu
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Lan Zhen
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Shaoyu Zhang
- Department of Gynecology, Fuding Municipal Hospital, Zhangzhou, Fujian, China
| | - Yurong Cai
- Department of Gynecology, Zhangpu County Traditional Chinese Medicine Hospital, Zhangzhou, Fujian, China
| | - Yanying Lin
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Fulian Chen
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Xiaowen Li
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Qianru You
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Xiaohong Lai
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China,Department of Gynecology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Hangbo Lai
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Xiangqin Zheng
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China,Xiangqin Zheng,
| | - Huan Yi
- Department of Gynecology Oncology, Fujian Provincial Maternity and Children’s Hospital, Fujian Provincial Key Gynecology Clinical Specialty, The Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China,*Correspondence: Huan Yi,
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Ueno Y, Toyoshima M, Shigemi D, Yumori A, Wakabayashi R, Kitagawa M, Konnai K, Onose R, Suzuki S, Kato H. Significance of positive peritoneal cytology for recurrence and survival in patients with endometrial cancer. J Obstet Gynaecol Res 2023; 49:304-313. [PMID: 36210139 DOI: 10.1111/jog.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 01/19/2023]
Abstract
AIM This study aims to examine the association between malignant peritoneal cytology and prognosis in women with endometrial cancer. METHODS We retrospectively analyzed the records of patients with endometrial cancer who underwent surgery with intraoperative peritoneal cytology at our hospital between January 1988 and December 2012. All results were reclassified according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) system, and the relation between intraoperative peritoneal cytology results and recurrence and prognosis was examined. RESULTS Of the 908 patients analyzed, 205 (22.6%) had positive peritoneal cytology. Patients with positive peritoneal cytology had significantly lower rates of recurrence-free survival (RFS) and overall survival (OS) than those in the negative cytology group (both p < 0.001). Subgroup analysis of patients with FIGO stage I/II showed significantly lower RFS in the positive-cytology group (p = 0.005), but there was no significant difference in OS (p = 0.637). In the patients with FIGO stage III/IV or patients classified as "high risk," the RFS and OS were significantly lower in the positive-cytology group (both p < 0.001). Cox regression analysis identified positive peritoneal cytology as a significant predictor of recurrence in patients with FIGO stage I/II disease. CONCLUSIONS Patients with positive peritoneal cytology for endometrial cancer have a high risk of recurrence, regardless of histopathologic type or FIGO stage. Peritoneal cytology has already been removed from the 2009 FIGO classification of endometrial cancer, but it may deserve reconsideration.
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Affiliation(s)
- Yuta Ueno
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Economics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Asuna Yumori
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Reina Wakabayashi
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Masakazu Kitagawa
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Katsuyuki Konnai
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Ryo Onose
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
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Muacevic A, Adler JR, Arjani S, Quinn PL, Trivedi R, Chokshi RJ. Staging CT and Diagnostic Laparoscopy With Cytology Prior to the Treatment of Pancreatic Adenocarcinoma: A Case Series. Cureus 2022; 14:e31883. [PMID: 36579218 PMCID: PMC9792353 DOI: 10.7759/cureus.31883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Initial staging of pancreatic ductal adenocarcinoma (PDAC) is performed with computed tomography (CT). Laparoscopy with peritoneal cytology at staging can uncover occult disease undetected by CT. This case series assessed clinical course following staging laparoscopy with cytology in patients with PDAC. METHODS This single-center study examined patients with non-metastatic PDAC diagnosed from 2017 to 2020. Patients underwent CT and subsequent laparoscopy with cytology prior to treatment. Demographics, clinicopathologic status, treatment course, and survival were compared. RESULTS Eight patients were identified. All had negative laparoscopies. Five cytologies were negative, two were atypical, and one was positive. Two patients with negative cytology received neoadjuvant chemotherapy and underwent resection, with an average follow-up time of 32.9 months since diagnosis. Of the three remaining patients with negative cytology, none underwent resection. One received delayed chemotherapy, while the others could not due to medical contraindications. The average survival was 3.5 months (n=2). Of two patients with atypical cytology, neither underwent resection. One could not receive chemotherapy due to medical contraindication, while the other was lost to follow-up shortly after diagnosis. The average survival was 1.3 months (n=1). The patient with positive cytology received definitive chemotherapy without resection and survived for 21.6 months. CONCLUSIONS The patient with positive cytology may have been spared non-therapeutic surgery. Remaining unresected patients showed poor survival, though the lack of immediate chemotherapy may contribute to this finding. Further research is needed to determine optimal candidates for invasive staging and implications of atypical cytology.
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Behtash N, Sheikhhasani S, Nezamabadi V. Prognostic significance of positive peritoneal cytology in endometrial cancer patients. J OBSTET GYNAECOL 2022; 42:2336-2340. [PMID: 35470766 DOI: 10.1080/01443615.2022.2049725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although peritoneal cytology has been shown to be an independant predictor of survival in endometrial cancer, the present international federation of gynaecology and obstetrics (FIGO) staging system does not involve it for risk stratification. This work aimed to assess the prognostic importance of PPC (positive peritoneal cytology) in endometrial cancer patients. The medical profiles of uterine carcinoma patients were reviewed who were referred to Khatam-al- Anbia and Bahman hospital within 2010-2019. The factors possibly affecting peritoneal fluid cytology in all patients were analysed. There was a considerable association between survival and the number of lymph nodes involvement (95% CI = 2.5 - 12.51, OR = 5.59, p < .001), stage 3 (95% CI = 2.95-22.10, OR = 7.12, p < .001), stage IV (95% CI = 2.14 - 30.09, OR = 8.04, p < .001), Grade (95% CI = 4.4-47.7, OR = 14.54, p < .001). Positive peritoneal cytology was revealed in our study, as an independent prognostic factor in patients with endometrial cancer. Impact statementWhat is already known on this subject? Peritoneal cytology is one of the independent risk factors for poor survival for endometrial cancer, but international federation of gynaecology and obstetrics (FIGO) staging system does not involve it for risk stratification.What do the results of this study add? Positive peritoneal cytology was revealed in our study, as an independent prognostic factor in patients with endometrial cancer.What are the implications of these findings for clinical practice and/or further research? It is recommended peritoneal cytology for future FIGO staging reviews. Till now, peritoneal washings need to be still regarded as a key part for precise risk-stratification.
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Affiliation(s)
- Nadereh Behtash
- Department of Genecology and Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Sheikhhasani
- Department of Genecology and Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Nezamabadi
- Department of Genecology and Oncology, Tehran University of Medical Sciences, Tehran, Iran
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11
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Matsuo K, Matsuzaki S, Miller H, Nusbaum DJ, Walia S, Matsuzaki S, Shimada M, Klar M, Roman LD. Clinico-pathological significance of suspicious peritoneal cytology in endometrial cancer. J Surg Oncol 2021; 124:687-698. [PMID: 34118157 DOI: 10.1002/jso.26570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/20/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Suspicious peritoneal cytology refers to the result of peritoneal cytology testing that is insufficient in either quality or quantity for a definitive diagnosis of malignancy. This study examined characteristics and survival outcomes related to suspicious peritoneal cytology in endometrial cancer. METHODS A population-based retrospective study by querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program was conducted. A total of 41,229 women with Stage I-III endometrial cancer who had peritoneal cytologic sampling at hysterectomy from 2010 to 2016 were examined. A Cox proportional hazard regression model and a competing risk analysis with Fine-Gray model were fitted to assess survival outcome related to suspicious peritoneal cytology. RESULTS Suspicious peritoneal cytology was seen in 702 (1.7%) cases. In multivariable models, suspicious peritoneal cytology was associated with increased risk of endometrial cancer mortality (subdistribution-hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.29-2.20, p < 0.001) and all-cause mortality (adjusted-HR: 1.55, 95% CI: 1.27-1.90, p < 0.001) compared with negative peritoneal cytology. Sensitivity analysis demonstrated that suspicious peritoneal cytology had discrete overall survival improvement compared with malignant peritoneal cytology in a propensity score weighting model (HR: 0.85, 95% CI: 0.72-0.99, p = 0.049). CONCLUSION Our study suggests that suspicious peritoneal cytology may be a prognostic factor for decreased survival in endometrial cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Heather Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - David J Nusbaum
- Department of Urology, University of Chicago School of Medicine, Chicago, Illinois, USA
| | - Saloni Walia
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Satoko Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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12
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Benzerdjeb N, Durieux E, Tantot J, Isaac S, Fontaine J, Harou O, Glehen O, Kepenekian V, Alyami M, Villeneuve L, Laplace N, Traverse-Glehen A, Shisheboran-Devouassoux M, Bakrin N. Prognostic impact of combined progression index based on peritoneal grading regression score and peritoneal cytology in peritoneal metastasis. Histopathology 2020; 77:548-559. [PMID: 32060943 DOI: 10.1111/his.14092] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/22/2022]
Abstract
AIMS The peritoneal regression grading score (PRGS) and peritoneal cytology (PC) assess response to chemotherapy in peritoneal metastasis (PM) in a setting of palliative treatment by pressurized intraperitoneal aerosol chemotherapy (PIPAC). Progression has been defined as an increase of PRGS between first and third PIPAC procedures (iPRGS). iPRGSand positive peritoneal cytology were not associated with prognostic impact. These results may be explained by a lack of statistical power. Also, it is not known whether the mean or the highest PRGS among taken peritoneal biopsies bears the highest clinical value. We therefore conducted the largest prospective study to investigate the prognostic impact of PGRS, PC, and their combination, designated as combined progression index (CPI). METHODS AND RESULTS Patients with PM who underwent >3 PIPAC (n = 112) between December 2016 and February 2019 were prospectively included. A significant difference in OS and PFS according to CPI (used highest value of PRGS) was found (OS: CPI-, 83.3, 95% CI [49.8; NA] vs. CPI+, 48.1, 95% CI [38.5; 66.4] months; and PFS (respectively, 59.7, 95% CI [43.0; 96.0] vs. 33.7, 95% CI [30.4; 44.2] months). PRGS or PC had no independent prognostic impact. CPI+ was an independent predictor of worse prognosis, in OS (HR = 5.24, 95% CI [2.07; 13.26]), and PFS (HR = 4.41, 95% CI [1.40; 13.88]). CONCLUSIONS The CPI based on highest PRGS and PC was found to be independently associated with a worse prognosis for OS and for PFS in the setting of peritoneal metastasis. These results indicate that it should be of interest to systematically take peritoneal fluid for cytological examination and to implement the CPI in the therapeutic decision-making process in the context of PIPAC.
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Affiliation(s)
- Nazim Benzerdjeb
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Université Lyon 1, Lyon, France
| | - Emeline Durieux
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Juliet Tantot
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Sylvie Isaac
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Juliette Fontaine
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Harou
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Glehen
- EMR 3738, Université Lyon 1, Lyon, France.,Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Vahan Kepenekian
- EMR 3738, Université Lyon 1, Lyon, France.,Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mohammad Alyami
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laurent Villeneuve
- EMR 3738, Université Lyon 1, Lyon, France.,Service d'Epidémiologie et de Recherche Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Nathalie Laplace
- EMR 3738, Université Lyon 1, Lyon, France.,Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Alexandra Traverse-Glehen
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,INSERM 1052, CNRS 5286, Lyon-Sud Charles Mérieux Lyon-1 Faculty, Université Lyon 1, Lyon, France
| | - Mojgan Shisheboran-Devouassoux
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,INSERM 1052, CNRS 5286 Cancer Research Center of Lyon, Equipe labellisée Ligue contre le Cancer, Université Lyon 1, Lyon, France
| | - Naoual Bakrin
- EMR 3738, Université Lyon 1, Lyon, France.,Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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13
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Koyuncu K, Altın D, Turgay B, Varlı B, Konuralp B, Şükür YE, Taşkın S, Ortaç F. Binary grading may be more appropriate for endometrial cancer. J Turk Ger Gynecol Assoc 2020; 21:163-170. [PMID: 32885922 PMCID: PMC7495132 DOI: 10.4274/jtgga.galenos.2019.2019.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To elucidate the survival consequences of the prognostic factors for endometrial cancer. Material and Methods: This was a retrospective study of 276 patients diagnosed with endometrial cancer who admitted for staging surgery. The extent of the surgery was determined by clinical staging and preoperative evaluation. The pathology specimens were reassessed by a gynecopathologist. Independent risk factors were revealed for the progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) utilizing Kaplan-Meier and “Cox” proportional analysis. Results: The median follow up of the patients was 50 months. Of the 29 patients who died, 15 (5.43%) died because of endometrial cancer. Multivariate analysis revealed that independent risk factors for OS and PFS were stage (p=0.002, 0.002, respectively) and grade 3 (G3) histology (p=0.013, 0.015, respectively). Positive peritoneal cytology was an independent risk factor for OS (p=0.024), but not for PFS (p=0.050). Stage (p=0.005) was found to be the only independent risk factor for DSS. Patients with G1 and G2 histology had a similar and more favorable prognosis than patients with G3 histology. Conclusion: Advanced stage, high-grade tumor and the presence of positive peritoneal cytology were ascertained as independent prognostic factors for endometrial cancer. A binary histological grading system could be simpler and as effective as the current three grade system because grade 1 and 2 patients showed similar prognosis.
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Affiliation(s)
- Kazibe Koyuncu
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Duygu Altın
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Batuhan Turgay
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Bulut Varlı
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Bahar Konuralp
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Tepecik Traning and Research Hospital, İzmir, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Salih Taşkın
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fırat Ortaç
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
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14
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Kołomańska MM, Głuszek S. Free cancer cells in gastric cancer - methods of detection, clinical and prognostic importance (meta-analysis). Contemp Oncol (Pozn) 2020; 24:67-74. [PMID: 32514240 DOI: 10.5114/wo.2020.94724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/09/2020] [Indexed: 12/13/2022] Open
Abstract
Gastric cancer (GC) is one of the most common malignant cancers worldwide. Intraperitoneal dissemination is the typical mechanism of the formation of metastases in GC. The diagnosis of the presence of intraperitoneal free cancer cells (IFCCs) is treated equally to the M (metastasis) category according to the 8th edition of the TNM classification by the American Joint Committee on Cancer. IFCCs are cells which have detached from the primary tumour through exfoliation into the peritoneal cavity. The source of IFCCs may be iatrogenic due to improper surgical technique during resection of the tumour and may lead to intraperitoneal dissemination. Cytological examination of peritoneal lavage is considered as a gold standard in the confirmation of the presence of IFCCs; however, its sensitivity is very low. In order to increase the sensitivity and reliability of the examination, molecular biology techniques should be applied. In the case of detection of the presence of IFCCs in patients with GC, the patient should be qualified for chemotherapy, or possibly the use of hyperthermic intraperitoneal chemotherapy should be considered.
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15
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Li X, Cheng Y, Dong Y, Shen B, Yang X, Wang J, Zhou J, Wang J. An elevated preoperative serum calcium level is a significant predictor for positive peritoneal cytology in endometrial carcinoma. Chin J Cancer Res 2019; 31:965-973. [PMID: 31949398 PMCID: PMC6955164 DOI: 10.21147/j.issn.1000-9604.2019.06.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate preoperative serum calcium concentration and investigate the association between calcium level and positive peritoneal cytology in endometrial carcinoma (EC). Methods A total of 510 patients who were diagnosed with EC and had surgery were initially enrolled in this study at Peking University People’s Hospital between January 2012 and December 2016. Clinical characteristics and preoperative serum calcium, albumin, carbohydrate antigen (CA)125, CA19-9, carcinoembryonic antigen (CEA) were extracted from patient records and evaluated according to postoperative peritoneal cytology. Predictive factors were assessed with Cox univariate and multivariate analyses. Factors selected from multivariate analysis results were used to build a predictive model. Results A total of 510 patients are identified in our database and 444 patients who fulfilled inclusion and exclusion criteria are included in this study. Univariate analysis revealed that ionized calcium concentration was closely related to positive peritoneal cytology, tumor grade and lymph-vascular space invasion (LVSI). Moreover, peritoneal cytology was significantly associated with hypertension, tubal ligation, serum CA125, CA19-9, CEA and ionized calcium level. Multivariate analysis revealed that albumin-adjusted calcium level, CA125 and tubal ligation were independent predictive factors of positive peritoneal cytology (P<0.05). A combination of ionized calcium level with the other two indexes yielded significantly great area under the curve (AUC=0.824). Conclusions This study enhanced the value of preoperative ionized calcium level. We also identified several potential biomarkers to predict positive peritoneal cytology in EC patients before surgery.
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Affiliation(s)
- Xingchen Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Yuan Cheng
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Yangyang Dong
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Boqiang Shen
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xiao Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Jiaqi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders Diseases, Beijing 100044, China
| | - Jingyi Zhou
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders Diseases, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
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16
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Hoskovec D, Varga J, Dytrych P, Konecna E, Matek J. Peritoneal lavage examination as a prognostic tool in cases of gastric cancer. Arch Med Sci 2017; 13:612-616. [PMID: 28507577 PMCID: PMC5420630 DOI: 10.5114/aoms.2016.64044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/02/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Peritoneal tumor seeding is a common form of recurrence after gastric cancer surgery. The finding of free tumor cells and/or elevation of tumor markers in the peritoneal fluid could predict intraperitoneal tumor recurrence. The results of these examination can be used for indication of aggressive treatment modalities such as hyperthermic intraperitoneal chemotherapy (HIPEC). MATERIAL AND METHODS We have operated on 105 patients suffering from gastric cancer. The control group consisted of 12 patients without malignant disease. Peritoneal lavage fluid or ascites was collected immediately after laparotomy and examined by cytology and biochemistry (levels of carcinoembryonic antigen (CEA) and Ca 19-9). Sensitivity, specificity, stage correlation and overall survival were observed. RESULTS Elevation of tumor markers or the finding of free intraperitoneal tumor cells predicts recurrence. The prognosis of these patients is same as in stage IV TNM classification with median survival time less than 1 year (p = 0.713). Patients with negative cytology have median survival time 5 years contrary to them with positive cytology (p < 0.001). Sensitivity of the cytology was 34% and specificity was 85%. Sensitivity of biochemistry was 53% (combination of both markers) and specificity was 100%. CONCLUSIONS This study confirms the importance of peritoneal fluid examination for the prognosis. We cannot recommend routine use as an indicator for HIPEC due to low sensitivity, but the result of cytological examination is an independent factor for patient survival.
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Affiliation(s)
- David Hoskovec
- 1 Department of Surgery, General University Hospital, Prague, Czech Republic
| | - Jozef Varga
- Department of Surgery, Hospital Bulovka, Prague, Czech Republic
| | - Petr Dytrych
- 1 Department of Surgery, General University Hospital, Prague, Czech Republic
| | - Ellen Konecna
- 1 Department of Surgery, General University Hospital, Prague, Czech Republic
| | - Jan Matek
- 1 Department of Surgery, General University Hospital, Prague, Czech Republic
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17
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Ilhan E, Alemdar A, Ureyen O, Bas K. The Importance of Extensive Intraoperative Peritoneal Lavage as a Promising Method in Patients with Gastric Cancer Showing Positive Peritoneal Cytology Without Overt Peritoneal Metastasis and Other Therapeutic Approaches. J INVEST SURG 2016; 30:318-324. [PMID: 27806214 DOI: 10.1080/08941939.2016.1247930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Peritoneal invasion is more common and has a worse prognosis in gastric cancer than most of other intestinal cancers. Advanced gastric cancers have a poor course in terms of the development of peritoneal carcinomatosis and prognosis, even if the curative resection has been performed. Patients usually die within the first 2 years of the postoperative period mainly due to peritoneal metastasis. It is, therefore, essential to eradicate intraperitoneal free cancer cells to prevent peritoneal recurrences. A standard therapy has not been developed yet for patients with gastric cancer with a positive peritoneal cytology or a gross peritoneal metastasis. Curative resection following neoadjuvant chemotherapy, postoperative oral S-1 chemotherapy, intraoperative intraperitoneal chemotherapy (IPC), and extensive intraoperative peritoneal lavage (EIPL)-IPC are recommended as therapeutic approaches. Although there is a limited number of studies on EIPL, which is a promising and exciting method in this patient population, unexpected results of survival have been demonstrated. We consider that the results of ongoing and further studies would lead to an extensive use of EIPL, which is a simple and easy method which can be applied anywhere and anytime, in patients with advanced gastic cancer and/or peritoneal cytology positive but peritoneal metastasis negative (CY+/P0) gastric cancer.
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Affiliation(s)
- Enver Ilhan
- a Izmir Bozyaka Training and Research Hospital, The Division of General Surgery-A , Karabaglar , 35170 Turkey
| | - Ali Alemdar
- b Okmeydani Training and Research Hospital, The Division of General Surgery , Okmeydani , 34384 Turkey
| | - Orhan Ureyen
- a Izmir Bozyaka Training and Research Hospital, The Division of General Surgery-A , Karabaglar , 35170 Turkey
| | - Koray Bas
- a Izmir Bozyaka Training and Research Hospital, The Division of General Surgery-A , Karabaglar , 35170 Turkey
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18
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Aumiphin J, Crochet P, Knight S, Carcopino X, Cravello L, Boubli L, Agostini A. Outcome and Follow-up of Patients with Endometrial Carcinoma Diagnosed on Operative Hysteroscopic Resection Specimens. Anticancer Res 2016; 36:4341-4345. [PMID: 27466554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
AIM To study outcomes of patients diagnosed with endometrial carcinoma (EC) after histological analysis of endometrial resections retrieved during operative hysteroscopy performed for a presumed benign lesion. PATIENTS AND METHODS A retrospective study was conducted using medical records of patients who underwent operative hysteroscopy for a presumed benign lesion with a final diagnosis of EC between January 1994 and April 2014 in two tertiary academic centers. RESULTS A total of 29 patients were selected. International federation of gynecology and obstetrics (FIGO) classification was distributed as follows: 16 stages IA, 7 stages IB, 4 stages II and 2 stages III. Peritoneal cytology was positive in one case (stage IIIA). Median follow-up was 4.2 years (range=0.3-20.51). Two deaths were observed and were attributed to endometrial cancer. CONCLUSION Operative hysteroscopy does not appear to influence stage of EC nor cause retrograde seeding of EC for 27/29 (93%) patients. For 2 patients, the impact of operative hysteroscopy remains uncertain.
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Affiliation(s)
- Julia Aumiphin
- Department of Obstetrics and Gynecology, Hôpital La Conception, Marseille, France
| | - Patrice Crochet
- Department of Obstetrics and Gynecology, Hôpital La Conception, Marseille, France
| | - Sophie Knight
- Department of Obstetrics and Gynecology, Hôpital La Conception, Marseille, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, Marseille, France
| | - Ludovic Cravello
- Department of Obstetrics and Gynecology, Hôpital La Conception, Marseille, France
| | - Leon Boubli
- Department of Obstetrics and Gynecology, Hôpital Nord, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Marseille, France
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Dovnik A, Crnobrnja B, Zegura B, Takac I, Pakiz M. Incidence of positive peritoneal cytology in patients with endometrial carcinoma after hysteroscopy vs. dilatation and curettage. Radiol Oncol 2016; 51:88-93. [PMID: 28265237 PMCID: PMC5330164 DOI: 10.1515/raon-2016-0035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/28/2016] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the study was to compare the frequency of positive peritoneal washings in endometrial cancer patients after either hysteroscopy (HSC) or dilatation and curettage (D&C). Patients and methods We performed a retrospective analysis of 227 patients who underwent either HSC (N = 144) or D&C (N = 83) and were diagnosed with endometrial carcinoma at the University Medical Centre Maribor between January 2008 and December 2014. The incidence of positive peritoneal cytology was evaluated in each group. Results There was no overall difference in the incidence of positive peritoneal washings after HSC or D&C (HSC = 13.2%; D&C = 12.0%; p = 0.803). However, a detailed analysis of stage I disease revealed significantly higher rates of positive peritoneal washings in the HSC group (HSC = 12.8%; D&C = 3.4%; p = 0.046). Among these patients, there was no difference between both groups considering histologic type (chi-square = 0.059; p = 0.807), tumour differentiation (chi-square = 3.709; p = 0.156), the time between diagnosis and operation (t = 0.930; p = 0.357), and myometrial invasion (chi-square = 5.073; p = 0.079). Conclusions Although the diagnostic procedure did not influence the overall incidence of positive peritoneal washings, HSC was associated with a significantly higher rate of positive peritoneal cytology in stage I endometrial carcinoma compared to D&C.
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Affiliation(s)
- Andraz Dovnik
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Bojana Crnobrnja
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Branka Zegura
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Iztok Takac
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
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Ditto A, Martinelli F, Carcangiu M, Lorusso D, Raspagliesi F. Peritoneal cytology as prognostic factor in cervical cancer. Diagn Cytopathol 2015; 43:705-9. [PMID: 26139073 DOI: 10.1002/dc.23296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/02/2015] [Accepted: 04/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND To investigate the prognostic role of peritoneal cytology (PC) in cervical cancer patients undergoing radical hysterectomy. METHODS We retrospectively analyzed 120 stage IA1-IIIB patients with cervical cancer who underwent peritoneal fluid collection for cytology during radical hysterectomy. Neoadjuvant chemotherapy and/or radiotherapy was performed in 48% of the cases. All PC specimens were obtained by aspiration of free-fluid when present or by peritoneal washing. The relationships between cytological diagnosis, histological variables, and prognosis were investigated. RESULTS PC was positive in 4 out of 120 (3.3%) cases. All were advanced stage adenocarcinomas. Overall, 4 out of 26 (15.3%) cases with adenocarcinoma were positive, and all presented with free fluid in the pelvis. No positive PC was found among squamous cancers. Histological subtype (P: 0.002) and parametrial (P < 0.001) and vaginal (P: 0.002) involvement presented a statistically significant correlation with PC positivity. The prognostic analysis of histological parameters demonstrated that parametrial (P: 0.007), vaginal (P: 0.04), and lymph node involvements (P: 0.003) were significantly correlated with a shorter disease-free survival. CONCLUSIONS The series indicates that PC in squamous cell cervical cancer is not a significant prognostic factor. Its routine collection in squamous cancer should be abandoned in this setting. On the other hand, the unfavorable prognostic profile of PC positive cases in our investigation suggest a possible impact of this variable on outcome. The significant link between PC and locally advanced adenocarcinomas underwent neoadjuvant therapy before surgery warrants a further investigation to assess its real prognostic value and its indication in this particular clinical setting.
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Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marialuisa Carcangiu
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Nagasaka K, Kawana K, Tomio K, Tsuruga T, Mori-Uchino M, Miura S, Tanikawa M, Miyamoto Y, Ikeda Y, Sone K, Adachi K, Matsumoto Y, Arimoto T, Oda K, Osuga Y, Fujii T. Positive peritoneal cytology at interval surgery is a poor prognostic factor in patients with stage T3c advanced ovarian carcinoma: A retrospective study. J Obstet Gynaecol Res 2014; 41:755-62. [PMID: 25421004 DOI: 10.1111/jog.12616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/08/2014] [Indexed: 01/02/2023]
Abstract
AIM The purpose of our study is to investigate clinically significant prognostic factors at the time of interval surgery (IS), comprising interval look surgery and interval debulking surgery, for T3c (International Federation of Gynecology and Obstetrics stage IIIc to IV) advanced ovarian cancer (AOC) patients during primary treatment. METHODS We reviewed records of patients with T3c AOC who underwent IS following neoadjuvant chemotherapy or up-front primary debulking surgery with adjuvant chemotherapy at our institution between January 1996 and December 2010. For analysis of prognostic factors, cytology of peritoneal exfoliative cells at IS was added to clinicopathological variables. RESULTS A retrospective analysis was performed on 50 cases. The median age was 61.1 years (range, 38-78), with median follow-up of 45.9 months (range, 12-122). Macroscopic tumors were completely resected in 32 cases (64%) at IS. Univariate analyses of clinicopathological factors for IS identified preoperative serum cancer antigen-125 levels (≥20 IU/mL; P = 0.0539), number of residual lesions at IS (≥20; P = 0.0554), incomplete surgery at IS (P = 0.0171) and positive peritoneal cytology at IS (P = 0.0015) as significant factors for prognosis regarding progression-free survival (PFS). Multivariate analysis identified positive peritoneal cytology (P = 0.0303) as a unique independent predictor of poor prognosis in PFS. CONCLUSION Positive peritoneal cytology at IS appears to be a significant factor for poor prognosis in PFS, which may provide useful information for post-IS chemotherapy planning. IS in the treatment of AOC may be useful for not only complete resection, but also for identification of patients with poor prognosis.
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Affiliation(s)
- Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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De Andrade JP, Mezhir JJ. The critical role of peritoneal cytology in the staging of gastric cancer: an evidence-based review. J Surg Oncol 2014; 110:291-7. [PMID: 24850538 DOI: 10.1002/jso.23632] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/05/2014] [Indexed: 12/20/2022]
Abstract
Positive peritoneal cytology (Cyt+) is an important staging tool for patients with locally advanced gastric cancer. The objective of this review is to evaluate the current literature regarding cytology evaluation in patients with gastric cancer and to provide recommendations on the inclusion of this powerful prognosticator in patients with this disease. A literature search was performed for recent and pertinent studies evaluating peritoneal cytology in patients with gastric adenocarcinoma. Peritoneal cytology as the only evidence for M1 disease is present in up to 10% of patients with locally advanced gastric cancer; survival in the setting of Cyt+ is dismal when gastrectomy is the first line of therapy. Improved survival is associated with response to chemotherapy indicated by conversion to negative cytology, good performance status, and antral tumors. Highly select patients with Cyt+ treated with gastrectomy show improved survival in only some of the available studies. There are high quality studies that support the routine practice of peritoneal cytology evaluation in patients with locally advanced gastric cancer. The role of gastrectomy remains unclear in patients with Cyt+ and clinical trials are needed to define the best treatment option for this select group of patients.
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Affiliation(s)
- James P De Andrade
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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23
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Kitayama J, Emoto S, Yamaguchi H, Ishigami H, Kamei T, Yamashita H, Seto Y, Matsuzaki K, Watanabe T. Flow cytometric quantification of intraperitoneal free tumor cells in patients with peritoneal metastasis. Cytometry B Clin Cytom 2013; 86:56-62. [PMID: 24115348 DOI: 10.1002/cyto.b.21126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/21/2013] [Accepted: 08/12/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Peritoneal metastasis (PM) is the most life-threatening type of metastasis in abdominal malignancy. To improve the diagnostic accuracy of cytologic detection (CY) of free tumor cells (FTC) in the peritoneal cavity, we tried to quantify the FTC to leukocyte ratio using flow cytometry in patients with peritoneal metastasis. METHODS Cells were recovered from ascites or peritoneal lavages from 106 patients who underwent abdominal surgery and additional 89 samples which were obtained from peritoneal catheter or access port in patients with PM (+) gastric cancer. The cells were immunostained with monoclonal antibodies to CD45 and to CD326 (EpCAM). Using flow cytometry, CD326 (+) and CD45 (+) cells were classified as either tumor cells (T) or leukocytes (L) and the T/L ratio (TLR) was calculated. RESULTS In 106 samples obtained by laparotomy, Median (M) of the TLR of PM (+) patients was 1.39% (0-807.87%) which was significantly higher than PM (-) patients (M=0%, 0-2.14%, P < 0.001). In PM (+) patients, 86 CY (+) samples showed higher TLR than 61 CY (-) samples (M=2.81%, 0.02-1868.44% vs. M=0%, 0-3.45%, p<0.0001). In all of the 24 patients who were monitored for TLR before and after intraperitoneal (IP) chemotherapy, the TLR was reduced which was more dramatic than the results of the change in cytology. CONCLUSIONS TLR measured with FACS is an excellent reflection of the tumor spread in the peritoneal cavity and could be a reliable diagnostic biomarker to determine the severity of PM as well as effectiveness of IP chemotherapy.
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Affiliation(s)
- Joji Kitayama
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
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Kitayama J, Emoto S, Yamaguchi H, Ishigami H, Kamei T, Yamashita H, Seto Y, Matsuzaki K, Watanabe T. Flow cytometric quantification of intraperitoneal free tumor cells (FTC) in patients with peritoneal metastasis. Cytometry B Clin Cytom 2013:n/a-n/a. [PMID: 24038963 DOI: 10.1002/cytob.21126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/21/2013] [Accepted: 08/12/2013] [Indexed: 11/06/2022]
Abstract
Background: Peritoneal metastasis (PM) is the most life-threatening type of metastasis in abdominal malignancy. To improve the diagnostic accuracy of cytologic detection (CY) of free tumor cells (FTC) in the peritoneal cavity, we tried to quantify the FTC to leukocyte ratio using flow cytometry in patients with peritoneal metastasis. Methods: Cells were recovered from ascites or peritoneal lavages from 106 patients who underwent abdominal surgery and additional 89 samples which were obtained from peritoneal catheter or access port in patients with PM (+) gastric cancer. The cells were immunostained with monoclonal antibodies to CD45 and to CD326 (EpCAM). Using flow cytometry, CD326 (+) and CD45 (+) cells were classified as either tumor cells (T) or leukocytes (L) and the T/L ratio (TLR) was calculated. Results: In 106 samples obtained by laparotomy, Median (M) of the TLR of PM (+) patients was 1.39% (0-807.87%) which was significantly higher than PM (-) patients (M=0%, 0-2.14%, p<0.001). In PM (+) patients, 86 CY (+) samples showed higher TLR than 61 CY (-) samples (M=2.81%, 0.02-1868.44% vs. M=0%, 0-3.45%, p<0.0001). In all of the 24 patients who were monitored for TLR before and after intraperitoneal chemotherapy, the TLR was reduced which was more dramatic than the results of the change in cytology. Conclusion: TLR measured with FACS is an excellent reflection of the tumor spread in the peritoneal cavity and could be a reliable diagnostic biomarker to determine the severity of PM as well as effectiveness of IP chemotherapy. © 2013 Clinical Cytometry Society.
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Affiliation(s)
- Joji Kitayama
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
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Tognon G, Carnazza M, Ragnoli M, Calza S, Ferrari F, Gambino A, Zizioli V, Notaro S, Sostegni B, Sartori E. Prognostic factors in early-stage ovarian cancer. Ecancermedicalscience 2013; 7:325. [PMID: 23781280 PMCID: PMC3680229 DOI: 10.3332/ecancer.2013.325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 01/06/2023] Open
Abstract
The purpose of this study was to identify the main prognostic factors in patients with early-stage epithelial ovarian cancer. Data were extracted from 222 patients with initial stage (I-IIA) invasive epithelial ovarian cancer treated with primary surgery followed or not followed by adjuvant therapy, from 1 January 1980 to 31 December 2008, at the Division of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy; the median follow-up was 79 months (SD ± 35,945, range 20-250 months). The negative prognostic factors that were statistically significant (p<0.050) in univariate analysis were grade 2, 3, and X (clear cell in our study); stage IB, IC, IIA; positive peritoneal cytology, age equal to/greater than 54; dense adhesions; capsule rupture (pre-operative or intra-operative) and endometrioid histotype (only for disease-free survival (DFS)). Positive cytology was strongly associated with peritoneal relapses, while adhesions were associated with pelvic relapses. A positive prognosis was associated with the mucinous histotype. Conservative treatment had been carried out in 52% of patients under 40 years of age, and we detected only two relapses and three completions of surgery after a few weeks among 31 women in total. Our study indicated a possible execution in patients with patients with cancer stage IA G1-G2 (p=0.030) or IC G1 (p=0.050), provided well staged. Adjuvant chemotherapy improved the survival of cancers that were not IA G1. The positive prognostic role of taxanes must be emphasised, when used in combination with platino.
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Affiliation(s)
- Germana Tognon
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Mario Carnazza
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Monica Ragnoli
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Stefano Calza
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Angela Gambino
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Valentina Zizioli
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Sara Notaro
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Benedetta Sostegni
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
| | - Enrico Sartori
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Italy
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Tourani SS, Cabalag C, Link E, Chan STF, Duong CP. Laparoscopy and peritoneal cytology: important prognostic tools to guide treatment selection in gastric adenocarcinoma. ANZ J Surg 2013; 85:69-73. [PMID: 23647832 DOI: 10.1111/ans.12197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have suggested that patients with occult peritoneal metastases not seen on preoperative imaging have poor prognosis. In this study, we aim to evaluate the utility and impact of staging laparoscopy and peritoneal cytology in patients with gastric adenocarcinoma. METHODS A retrospective analysis of patients with gastric adenocarcinoma managed at two major metropolitan hospitals in Melbourne, Australia, between January 1999 and July 2010 was undertaken. The main outcome measures were the number of patients in whom laparoscopy and/or peritoneal cytology changed treatment intent, and the overall survival of patients with occult metastases detected by laparoscopy/cytology. RESULTS Staging laparoscopy as an independent procedure was performed in 74.3% (148/199) of patients who had neither unequivocal metastases (M1) on preoperative imaging nor early T1 disease on endoscopic ultrasound. Laparoscopy/cytology detected occult metastases in 38 (25.6%) patients (27 macroscopic M1 and 11 microscopic M1 with positive peritoneal cytology only), leading to change in the treatment intent in 37 cases. The median overall survivals of patients with metastatic disease detected at staging laparoscopy (8.3 months, 95% confidence interval (CI) 5.4-16.5) or on peritoneal cytology (4.9 months, 95% CI 4.2-48) were as poor as those with M1 disease seen on preoperative imaging (6.7 months, 95% CI 4.2-8.9), P = 0.97. CONCLUSIONS Laparoscopy and peritoneal cytology add incremental value to modern imaging in the staging of gastric adenocarcinomas by detecting occult metastatic disease. Their utility needs to be optimized to allow better treatment selection for gastric cancer patients.
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Affiliation(s)
- Saam S Tourani
- Department of Surgery, Western Health, Footscray, Victoria, Australia
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Kasamatsu T, Onda T, Katsumata N, Sawada M, Yamada T, Tsunematsu R, Ohmi K, Sasajima Y, Matsuno Y. Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus. Br J Cancer 2003; 88:245-50. [PMID: 12610496 PMCID: PMC2377042 DOI: 10.1038/sj.bjc.6600698] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A retrospective analysis was performed to evaluate the prognostic significance of peritoneal cytology in patients with endometrial carcinoma limited to the uterus. A total of 280 patients with surgically staged endometrial carcinoma that was histologically confined to the uterus were examined clinicopathologically. The median length of follow-up was 62 (range, 12-135) months. All patients underwent hysterectomy and salpingo-oophorectomy with selective lymphadenectomy, and only three patients received adjuvant postoperative therapy. No preoperative adjuvant therapy was employed. In all, 48 patients (17%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative peritoneal cytology was 91 or 95%, respectively, showing no significant difference (log-rank, P=0.42). The disease-free survival rate at 36 months was 90% among patients with positive cytology, compared with that of 94% among patients with negative cytology, and the difference was not significant (log-rank, P=0.52). Multivariate proportional hazards model revealed only histologic grade to be an independent prognostic factor of survival (P=0.0003, 95% CI 3.02 - 40.27) among the factors analysed (age, peritoneal cytology, and depth of myometrial invasion). Multivariate analysis revealed that histologic grade (P=0.02, 95% CI 1.21-9.92) was also the only independent prognostic factor of disease-free survival. We concluded that the presence of positive peritoneal cytology is not an independent prognostic factor in patients with endometrial carcinoma confined to the uterus, and adjuvant therapy does not appear to be beneficial in these patients.
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Affiliation(s)
- T Kasamatsu
- Division of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
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Abstract
BACKGROUND Free tumour cells in the peritoneal cavity of patients with pancreatic carcinoma carry a poor prognosis. Reactive or degenerative mesothelial cells can make cytological interpretation with conventional stains difficult. Detection of the tumour-associated antigens carcinoembryonic antigen (CEA) and CA19-9 may improve detection. METHODS At staging laparoscopy, 22 patients with pancreatic or periampullary tumours had ascitic fluid aspirated or peritoneal lavage performed. Both conventional and immunocytologically stained preparations were examined. Antibodies to CEA and CA19-9 and the epithelial marker BerEP4 were used. Lavage fluid from ten patients having operative treatment for benign pancreatic or biliary conditions was also examined. RESULTS No malignant cells on conventional cytological criteria were recovered.Thirteen of the 22 patients with pancreatic or periampullary carcinoma had peritoneal cells that were positive for CEA and/or CA19-9. None was positive for BerEP4. No patients with resectable disease had cells that were positive for CEA or CA19-9 compared with 13 of 18 (72%) who had unresectable disease. One patient (10%) with benign disease (chronic pancreatitis) had cells recovered that were weakly positive for CEA but negative for CA19-9 and BerEP4. DISCUSSION Recovery of cells from the peritoneal cavity of patients with pancreatic or periampullary carcinoma that are expressing the tumour-associated antigens CEA or CA19-9 does not indicate the presence of free tumour cells but is associated with advanced disease.
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Affiliation(s)
| | - A Watson
- HPB Surgery Unit, Freeman Hospital
| | - V Wadehra
- Department of Cytology, Royal Victoria InfirmaryNewcastle upon TyneUK
| | - RM Charnley
- Department of Cytology, Royal Victoria InfirmaryNewcastle upon TyneUK
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Abstract
Many patients undergoing surgery for gastric carcinoma will develop peritoneal metastases. A method to identify those patients at risk of peritoneal recurrence would help in the selection of patients for adjuvant therapy. Peritoneal cytology has received little attention in the West, but may prove a useful additional means of evaluating patients with gastric cancer. The aims of this study were to evaluate sampling techniques for peritoneal cytology in patients with gastric cancer, to assess the prognostic significance of free peritoneal malignant cells and to discover the effect of the operative procedure on dissemination of malignant cells. The study is based on 85 consecutive patients undergoing surgical treatment of gastric cancer and followed up for 2 years or until death. Peritoneal cytology samples were collected at laparoscopy, and at operation prior to resection by intraperitoneal lavage and serosal brushings. After resection, samples were taken by peritoneal lavage, imprint cytology of the resected specimen and post-operatively by peritoneal irrigation via a percutaneous catheter. Malignant cells were diagnosed by two independent microscopists. Preoperative peritoneal lavage yielded malignant cells in 16 out of 85 cases (19%). The yield of free malignant cells was increased by using serosal brushings (by four cases) and imprint cytology (by two cases); all of the cases had evidence of serosal penetration. One serosa-negative case exhibited positive cytology in the post-resection peritoneal specimen in which the preresection cytology specimen was negative. Survival was worse in the cytology-positive group (chi2 = 25.1; P< 0.0001). Among serosa-positive patients, survival was significantly reduced if cytology was positive, if cases yielded by brushings and imprint cytology were included (log-rank test = 8.44; 1 df, P = 0.004). In conclusion, free peritoneal malignant cells can be identified in patients with gastric cancer who have a poor prognosis; the yield can be increased with brushings and imprint cytology in addition to conventional peritoneal lavage. Evaluation of peritoneal cytology by these methods may have a role in the selection of patients with the poorest prognosis who may benefit most from adjuvant therapy.
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Affiliation(s)
- N Hayes
- The Northern Oesophago-Gastric Cancer Unit, The Royal Victoria Infirmary, Newcastle upon Tyne, UK
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