Significance of Malignant Peritoneal Cytology on Survival of Women with Uterine Sarcoma
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ORIGINAL ARTICLE – GYNECOLOGIC ONCOLOGY
Significance of Malignant Peritoneal Cytology on Survival of Women with Uterine Sarcoma Koji Matsuo, MD, PhD1,2 , Shinya Matsuzaki, MD, PhD1, David J. Nusbaum, BS1, Sohee Ki, BS3, Erica J. Chang, MD1, Maximilian Klar, MD, MPH4, and Lynda D. Roman, MD1,2 1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; 2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; 3Keck School of Medicine, University of Southern California, Los Angeles, CA; 4Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
ABSTRACT Purpose. This study was designed to examine the association between malignant peritoneal cytology and survival of women with uterine sarcoma. Methods. This retrospective, observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program. Uterine sarcoma cases diagnosed from 2010 to 2016 with known peritoneal cytology results were examined. Propensity score inverse probability of treatment weighting was fitted to balance the measured covariates. Overall survival (OS) was compared between malignant and negative cytology cases. Results. A total of 1481 uterine sarcomas were examined. Malignant peritoneal cytology was seen in 146 (9.9%) cases. Women who had T3 disease and distant metastases had the highest incidence of malignant peritoneal cytology (43.1%). In multivariable analysis, higher T stage, nodal involvement, distant metastasis, poorer tumor differentiation, and rhabdomyosarcoma/endometrial stromal sarcoma were significantly associated with an increased risk of malignant peritoneal cytology (all, P \ 0.05). In the weighted model, malignant peritoneal cytology was
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09202-1) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 14 May 2020 Accepted: 17 September 2020 K. Matsuo, MD, PhD e-mail: [email protected]
associated with a nearly twofold increased risk of all-cause mortality compared with negative peritoneal cytology (3year OS rate 34.7% versus 60.2%; hazard ratio 2.26; 95% confidence interval 1.88–2.71; P \ 0.001). The absolute difference in the 3-year survival rate was particularly large in leiomyosarcoma (3-year OS rate 2.8% versus 51.9%; hazard ratio 2.64; 95% confidence interval 1.94–3.59; P \ 0.001). Malignant peritoneal cytology was also associated with an increased all-cause mortality risk in early and advanced stages (both, P \ 0.05). Conclusions. Our study suggests that malignant peritoneal cytology may be a prognostic factor for increased mortality in uterine sarcoma, particularly in uterine leiomyosarcoma.
Uterine sarcoma is a group of mesenchymal tumors of the uterine corpus.1–4 It comprises less than 10% of uterine malignancies and is considered a rare tumor.1–4 For instance, the age-adjusted in
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