PDF(Pubmed)
Abstract：
Background and Objectives: The impact of positive peritoneal cytology has been a matter of controversy in early-stage endometrial cancer for several years. The latest staging systems do not take into consideration its presence; however, emerging evidence about its potential harmful effect on patient survival outcomes suggests otherwise. In the present systematic review and meta-analysis, we sought to accumulate current evidence. Materials and Methods: Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar and Clinicaltrials.gov databases were searched for relevant articles. Effect sizes were calculated in Rstudio using the meta function. A sensitivity analysis was carried out to evaluate the possibility of small-study effects and p-hacking. Trial sequential analysis was used to evaluate the adequacy of the sample size. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale. Results: Fifteen articles were finally included in the present systematic review that involved 19,255 women with early-stage endometrial cancer. The Newcastle-Ottawa scale indicated that the majority of included studies had a moderate risk of bias in their selection of participants, a moderate risk of bias in terms of the comparability of groups (positive peritoneal cytology vs. negative peritoneal cytology) and a low risk of bias concerning the assessment of the outcome. The results of the meta-analysis indicated that women with early-stage endometrial cancer and positive peritoneal cytology had significantly lower 5-year recurrence-free survival (RFS) (hazards ratio (HR) 0.26, 95% CI 0.09, 0.71). As a result of the decreased recurrence-free survival, patients with positive peritoneal cytology also exhibited reduced 5-year overall survival outcomes (HR 0.50, 95% CI 0.27, 0.92). The overall survival of the included patients was considerably higher among those that did not have positive peritoneal cytology (HR 12.76, 95% CI 2.78, 58.51). Conclusions: Positive peritoneal cytology seems to be a negative prognostic indicator of survival outcomes of patients with endometrial cancer. Considering the absence of data related to the molecular profile of patients, further research is needed to evaluate if this factor should be reinstituted in future staging systems.
摘要：
背景和目的：腹膜细胞学阳性对早期子宫内膜癌的影响多年来一直存在争议。最新的分期系统没有考虑到它的存在；然而，关于其对患者生存结局的潜在有害影响的新证据表明，情况并非如此。在本系统综述和荟萃分析中，我们试图积累目前的证据。材料与方法:Medline,Scopus,Cochrane中央受控试验中央登记册，搜索了GoogleScholar和Clinicaltrials.gov数据库以获取相关文章。在Rstudio中使用元函数计算效应大小。进行了敏感性分析，以评估小型研究效果和p黑客的可能性。试验序列分析用于评估样本量的充分性。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。结果：15篇文章最终纳入本系统综述，涉及19,255例早期子宫内膜癌妇女。纽卡斯尔-渥太华量表表明，大多数纳入的研究在选择参与者时存在中等偏倚风险，就组的可比性而言，中度偏倚风险(腹膜细胞学阳性与腹膜细胞学检查阴性），并且在评估结果方面存在较低的偏倚风险。荟萃分析结果表明，早期子宫内膜癌和腹膜细胞学检查阳性的妇女的5年无复发生存率（RFS）显着降低（风险比（HR）0.26，95％CI0.09，0.71）。由于无复发生存率下降，腹膜细胞学检查阳性的患者的5年总生存结局也降低(HR0.50,95%CI0.27,0.92).在腹膜细胞学检查无阳性的患者中，纳入患者的总生存期明显较高（HR12.76,95%CI2.78,58.51）。结论：腹膜细胞学检查阳性似乎是子宫内膜癌患者生存结局的阴性预后指标。考虑到缺乏与患者分子谱相关的数据，需要进一步的研究来评估这个因素是否应该在未来的分期系统中重新建立。
