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恶性腹膜细胞学检查可预测子宫内膜样子宫内膜癌预后不良及辅助治疗的差异获益：基于 SEER 数据库的倾向评分匹配分析
Authors Yang H
Received 16 April 2025
Accepted for publication 7 August 2025
Published 21 August 2025 Volume 2025:17 Pages 2637—2650
DOI https://doi.org/10.2147/IJWH.S534822
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Vinay Kumar
Hua Yang
Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People’s Republic of China
Correspondence: Hua Yang, Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People’s Republic of China, Email yangh353@mail.sysu.edu.cn
Background: The prognostic significance of malignant peritoneal cytology (PC) in endometrioid endometrial carcinoma (EC) and its clinical implications for adjuvant therapy selection remain controversial.
Methods: This retrospective cohort study analyzed 9631 endometrioid EC patients from Surveillance, Epidemiology, and End Results (SEER) Program data (2010– 2017). Prognostic determinants of overall survival (OS) were identified through Cox regression. Propensity score matching (PSM) generated balanced cohorts: 826 malignant PC, 148 atypical/suspicious PC, and 974 negative PC cases. Survival distributions were compared using Kaplan-Meier analysis.
Results: Univariable analysis identified significant OS associations with age, histopathological grade, tumor stage, and PC status (all p < 0.05). Multivariable analysis confirmed malignant PC as an independent prognostic factor. Post-PSM: Malignant PC subgroup showed significantly reduced OS vs others (p < 0.001). Stage-specific effects in malignant PC subgroup: Radiation improved OS only in regional disease (p = 0.016). Systemic therapy reduced OS in all-stage malignant PC (p = 0.022). Atypical/suspicious PC subgroup: No survival benefit from radiation (p = 0.71) or systemic therapy (p = 0.38).
Conclusion: Malignant PC independently predicts poor prognosis in endometrioid EC but requires cautious interpretation in therapeutic decision-making due to its differential adjuvant therapy effects. PC status alone cannot guide risk stratification; treatment decisions should integrate stage-specific efficacy data. Prospective validation is imperative.
Keywords: endometrioid endometrial carcinoma, malignant peritoneal cytology, propensity score matching, prognostic factor, overall survival