| Objective:The relationship between positive peritoneal fluid cytology and its clinicopathological characteristics and prognosis in patients with endometrial carcinoma was analyzed by means of systematic evaluation in order to provide evidence-based basis for the diagnosis and treatment of endometrial carcinoma.Methods:Relevant literatures on the relationship between positive peritoneal fluid cytology and its clinicopathological characteristics and prognosis in patients with endometrial carcinoma were searched by computer in PubMed,Embase,Medline,China Knowledge Network(CNKI),VIP information network(VIP)and Wanfang databases.The retrieval time was from establishment of each database to December2019.In strict accordance with the inclusion and exclusion criteria screening,evaluation of literature and extract data.The indexes related to clinicopathological characteristics were:Pathological type,Histological grade,Depth of muscular infiltration,Vascular space infiltration,Tumor diameter,Cervical stroma involvement,Lymph node metastasis and extrauterine metastasis such as uterine serous membrane layer involvement,attachment metastasis,greater omentum metastasis.The indexes related to survival information were:5-year overall survival,OS,5-year disease-free survival,5-year progression-free survival,DFS/PFS and the recurrence in 5 years.Meta analysis was performed on the extracted data with RevMan5.3 software.Odds ratio(OR)was used to describe the relationship between positive peritoneal fluid cytology and various clinicopathological characteristics and recurrence in patients with endometrial carcinoma.Survival information was described by Hazard ratio(HR)and 95%confidence interval(CI).Results:This study eventually included 30 references,including 14 literatures in Chinese,16 literatures in English,24 literatures related to clinicopathological characteristics and 13 literatures related to survival information.The quality evaluation of the included literatures was based on the Newcastle-Ottawa scale(NOS),and the score of each literature was≥6.Meta analysis was performed on the extracted relevant outcome indexes,and the results are as follows:1.Positive peritoneal fluid cytology was correlated with pathological types of non-endometrioid carcinoma(OR=3.59,95%CI:2.79-4.63,P<0.00001,I~2=22%)and high-grade adenocarcinoma(G3)(OR=1.80,95%CI:1.25-2.59,P=0.002,I~2=53%)in patients with endometrial carcinoma and the difference was statistically significant;When patients with endometrial carcinoma have clinicopathologic characteristics such as muscle infiltration depth≥1/2(OR=2.43,95%CI:1.90-3.10,P<0.00001,I~2=39%),vascular space infiltration(OR=1.70,95%CI:1.23-2.34,P=0.001,I~2=41%),cervical stroma involvement(OR=2.24,95%CI:1.66-3.03,P<0.00001,I~2=15%),lymphnodemetastasis(OR=3.09,95%CI:2.25-4.25,P<0.00001,I~2=0%)and extrauterine metastasis(uterine serous membrane layer involvement(OR=5.91,95%CI:1.96-17.76,P=0.002,I~2=0%)attachment metastasis(OR=3.76,95%CI:2.41-5.86,P<0.00001,I~2=26%),greater omentum metastasis(OR=10.55,95%CI:3.81-29.20,P<0.0001,I~2=0%)),the incidence of positive peritoneal fluid cytology was significantly increased,and the differences were statistically significant.2.There was no significant correlation between positive peritoneal fluid cytology and whether the tumor diameter of endometrial carcinoma was greater than 2cm(OR=2.31,95%CI:0.88-6.08,P=0.09,I~2=65%),and the difference was not statistically significant.Moreover,the sensitivity analysis shows that the conclusion was highly sensitive and with poor reliability.3.In terms of survival information,5-year OS(HR=2.35,95%CI:1.85-3.00,P<0.00001,I~2=36%)and5-year DFS/PFS(HR=2.69,95%CI:2.04-3.56,P<0.00001,I~2=30%)of patients with peritoneal fluid cytology positive endometrial carcinoma were lower than those with negative patients,with statistically significant differences;At the same time,the recurrence of patients with positive peritoneal fluid cytology in 5 years(OR=2.78,95%CI:2.03-3.81,P<0.00001,I~2=0%)were significantly more than those in negative patients,with statistical difference.Conclusion:1.In terms of the clinicopathological characteristics of endometrial cancer patients,this meta-analysis found that Positive peritoneal fluid cytology was associated with a variety of clinicopathological characteristics,such as non-endometrioid carcinoma,histological high-grade adenocarcinoma(G3),depth of muscular infiltration≥1/2,vascular space infiltration,Cervical stroma involvement,lymph node metastasis,and extrauterine metastasis(uterine serous membrane layer involvement,attachment metastasis,and greater omentum metastasis).But positive peritoneal fluid cytology was not associated with tumor diameter greater than 2cm.2.In terms of prognosis of patients with endometrial cancer,this meta-analysis showed that compared with patients with negative peritoneal fluid cytology,5-year OS and DFS/PFS were shorter in patients with positive peritoneal fluid cytology.At the same time,this meta-analysis suggested that patients with positive peritoneal fluid cytology were significantly more likely to have disease recurrence than patients with negative peritoneal fluid cytology.3.This study suggests that positive peritoneal fluid cytology is of great significance in the prognosis of patients with endometrial carcinoma and the cytological examination of peritoneal fluid should be emphasized in clinical work. |
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