[术前诊断性宫腔镜检查对非子宫内膜样癌患者腹腔细胞学和预后的影响]。

中华妇产科杂志 Pub Date : 2023-12-25 DOI:10.3760/cma.j.cn112141-20230831-00080

Z Y Zhai, L Yang, H Li, L W Li, Z H Shen, X B Zhang, Z Q Wang, J L Wang

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The impact of hysteroscopy examination on peritoneal cytology and prognosis was analyzed. Results: (1) There were no statistical differences in age, body mass index, tumor size, pathological characteristics, and treatment methods between the hysteroscopic group and the non-hysteroscopic group (all P>0.05), but the proportion of stage Ⅰ-Ⅱ patients in the hysteroscopic group was significantly higher than that in the non-hysteroscopic group [68% (30/44) vs 47% (25/53); χ2=4.32, P=0.038]. (2) Among 97 patients, 25 (26%, 25/97) of them were cytologically positive for ascites. The hysteroscopic group had a lower positive rate of peritoneal cytology than that in the non-hysteroscopy group, which was significantly different [11% (5/44) vs 38% (20/53); χ2=8.74, P=0.003]. Stratification according to surgical and pathological stages showed that the positive rate of peritoneal cytology in the hysteroscopic group (3%, 1/30) was lower than that in the non-hysteroscopic group (12%, 3/25) in the 55 patients with stage Ⅰ-Ⅱ, and that in the hysteroscopic group (4/14) was also lower than that in the non-hysteroscopic group (61%, 17/28) in the 42 patients with stage Ⅲ-Ⅳ. There were no significant differences (all P>0.05). (3) The 5-year disease-free survival (DFS) rate of the hysteroscopic group and the non-hysteroscopic group were respectively 72.7% and 60.4%, and there was no significant difference between the two groups (P=0.186). After stratification according to staging, the 5-year DFS rate were respectively 90.0% and 72.0% (P=0.051) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅰ-Ⅱ, and 35.7% and 50.0% (P=0.218) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅲ-Ⅳ, in which there were not statistically significant differences. The 5-year overall survival (OS) rate were respectively 86.4% and 81.1% between the hysteroscopic group and the non-hysteroscopic group, with no significant difference between the two groups (P=0.388). The 5-year OS rate were respectively 93.3% and 96.0% in the hysteroscopic group and non-hysteroscopic group for patients with stage Ⅰ-Ⅱ(P=0.872), and 71.4% and 67.9% in the hysteroscopic group and non-hysteroscopic group in patients with stage Ⅲ-Ⅳ (P=0.999), with no statistical significance. 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Stratification according to surgical and pathological stages showed that the positive rate of peritoneal cytology in the hysteroscopic group (3%, 1/30) was lower than that in the non-hysteroscopic group (12%, 3/25) in the 55 patients with stage Ⅰ-Ⅱ, and that in the hysteroscopic group (4/14) was also lower than that in the non-hysteroscopic group (61%, 17/28) in the 42 patients with stage Ⅲ-Ⅳ. There were no significant differences (all P>0.05). (3) The 5-year disease-free survival (DFS) rate of the hysteroscopic group and the non-hysteroscopic group were respectively 72.7% and 60.4%, and there was no significant difference between the two groups (P=0.186). 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引用次数: 0

摘要

目的探讨术前宫腔镜引导下活检和分段诊断及刮宫对非子宫内膜样癌腹腔播散风险和预后的影响。方法：收集北京大学人民医院2008年10月至2021年12月接受手术治疗并经病理证实为非子宫内膜样癌（包括浆液性癌、透明细胞癌、混合型腺癌、未分化癌等）的97例患者的临床和病理资料，进行回顾性分析。根据术前诊断方法，分为宫腔镜组（44 例）和非宫腔镜组（53 例）。分析宫腔镜检查对腹腔细胞学和预后的影响。结果：（1）宫腔镜组与非宫腔镜组在年龄、体重指数、肿瘤大小、病理特征、治疗方法等方面无统计学差异（均P>0.05），但宫腔镜组Ⅰ-Ⅱ期患者比例明显高于非宫腔镜组[68%（30/44）vs 47%（25/53）；χ2=4.32，P=0.038]。(2）97 例患者中，25 例（26%，25/97）腹水细胞学阳性。宫腔镜组腹水细胞学阳性率低于非宫腔镜组，差异显著[11% (5/44) vs 38% (20/53)；χ2=8.74，P=0.003]。根据手术和病理分期进行的分层显示，宫腔镜组腹腔细胞学阳性率（3%，1/30）低于非宫腔镜组（12%，3/25）、在55例Ⅰ-Ⅱ期患者中，宫腔镜组的阳性率（3%，1/30）低于非宫腔镜组（12%，3/25）；在42例Ⅲ-Ⅳ期患者中，宫腔镜组的阳性率（4/14）也低于非宫腔镜组（61%，17/28）。差异无学意义（P>0.05）。(3）宫腔镜组和非宫腔镜组的5年无病生存率（DFS）分别为72.7%和60.4%，两组间无显著差异（P=0.186）。根据分期进行分层后，Ⅰ-Ⅱ期患者宫腔镜组和非宫腔镜组的5年DFS率分别为90.0%和72.0%（P=0.051），Ⅲ-Ⅳ期患者宫腔镜组和非宫腔镜组的5年DFS率分别为35.7%和50.0%（P=0.218），差异无统计学意义。宫腔镜组和非宫腔镜组的5年总生存率分别为86.4%和81.1%，两组间差异无统计学意义（P=0.388）。对于Ⅰ-Ⅱ期患者，宫腔镜组和非宫腔镜组的5年生存率分别为93.3%和96.0%（P=0.872）；对于Ⅲ-Ⅳ期患者，宫腔镜组和非宫腔镜组的5年生存率分别为71.4%和67.9%（P=0.999），差异无统计学意义。结论在本组患者中，诊断性宫腔镜检查并不会增加手术时腹腔细胞学结果的阳性率，术前宫腔镜检查与非子宫内膜样癌的不良预后之间也没有明显的相关性。因此，对非子宫内膜样癌进行术前宫腔镜引导活检和分段诊断及刮宫可能是安全的。

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

Objective: To explore the effects of preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage on the risk of abdominal dissemination and prognosis of non-endometrioid carcinoma. Methods: The clinical and pathological data of 97 patients who underwent surgical treatment and were pathologically confirmed as non-endometrioid carcinoma (including serous carcinoma, clear cell carcinoma, mixed adenocarcinoma, and undifferentiated carcinoma, etc.) from October 2008 to December 2021 in Peking University People's Hospital, were collected for retrospective analysis. According to preoperative diagnostic methods, they were divided into hysteroscopic group (n=44) and non-hysteroscopic group (n=53). The impact of hysteroscopy examination on peritoneal cytology and prognosis was analyzed. Results: (1) There were no statistical differences in age, body mass index, tumor size, pathological characteristics, and treatment methods between the hysteroscopic group and the non-hysteroscopic group (all P>0.05), but the proportion of stage Ⅰ-Ⅱ patients in the hysteroscopic group was significantly higher than that in the non-hysteroscopic group [68% (30/44) vs 47% (25/53); χ²=4.32, P=0.038]. (2) Among 97 patients, 25 (26%, 25/97) of them were cytologically positive for ascites. The hysteroscopic group had a lower positive rate of peritoneal cytology than that in the non-hysteroscopy group, which was significantly different [11% (5/44) vs 38% (20/53); χ²=8.74, P=0.003]. Stratification according to surgical and pathological stages showed that the positive rate of peritoneal cytology in the hysteroscopic group (3%, 1/30) was lower than that in the non-hysteroscopic group (12%, 3/25) in the 55 patients with stage Ⅰ-Ⅱ, and that in the hysteroscopic group (4/14) was also lower than that in the non-hysteroscopic group (61%, 17/28) in the 42 patients with stage Ⅲ-Ⅳ. There were no significant differences (all P>0.05). (3) The 5-year disease-free survival (DFS) rate of the hysteroscopic group and the non-hysteroscopic group were respectively 72.7% and 60.4%, and there was no significant difference between the two groups (P=0.186). After stratification according to staging, the 5-year DFS rate were respectively 90.0% and 72.0% (P=0.051) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅰ-Ⅱ, and 35.7% and 50.0% (P=0.218) between the hysteroscopic and non-hysteroscopic groups of patients in stage Ⅲ-Ⅳ, in which there were not statistically significant differences. The 5-year overall survival (OS) rate were respectively 86.4% and 81.1% between the hysteroscopic group and the non-hysteroscopic group, with no significant difference between the two groups (P=0.388). The 5-year OS rate were respectively 93.3% and 96.0% in the hysteroscopic group and non-hysteroscopic group for patients with stage Ⅰ-Ⅱ(P=0.872), and 71.4% and 67.9% in the hysteroscopic group and non-hysteroscopic group in patients with stage Ⅲ-Ⅳ (P=0.999), with no statistical significance. Conclusions: Diagnostic hysteroscopy do not increase the rate of positive peritoneal cytology result at the time of surgery in this cohort, and no significant correlation between preoperative hysteroscopy examination and poor prognosis of non-endometrioid carcinoma is observed. Therefore, preoperative hysteroscopic guided biopsy and segmental diagnosis and curettage in non-endometrioid carcinoma maybe safe.

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中华妇产科杂志

CiteScore

2.10

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0.00%

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12682

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