Prognostic significance of positive peritoneal cytology in adenocarcinoma of the uterine cervix

Objective: A retrospective analysis was carried out to evaluate the prognostic significance of peritoneal cytology in cervical adenocarcinoma. Methods: The records of 107 patients with FIGO stage IB to IIB cervical adenocarcinoma who underwent hysterectomy were reviewed. Results: Sixteen patients (15%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative cytology was 50% or 87%, respectively, showing a significant difference (log-rank, P < 0.001). The recurrence-free survival (RFS) rate at 36 months in the cytology-positive or -negative group was 53% or 87%, respectively, the difference being significant (log-rank, P = < 0.001). Cox model analysis revealed positive cytology [hazards ratio (HR) 6.27, 95% confidence interval (CI) 2.13-18.41], positive lymph node (HR 6.20, 95% CI 1.87-20.57), ovarian metastasis (HR 5.20, 95% CI 1.18-22.82), and histological grade (HR 5.97, 95% CI 2.00-17.78) to be independent adverse risk factors for survival among the factors analyzed (lymph node status, lymph-vascular space invasion, tumor size, depth in cervical wall, pathological parametrial involvement, infiltration to vagina, ovarian metastasis, and histological grade). Cox model analysis showed that positive cytology (HR 4.58, 95% CI 1.48-14.16), positive lymph node (HR 7.61, 95% CI 2.69-21.54), and histological grade (HR6.13, 95% CI 2.14-17.77) were independent adverse risk factors for RFS. The incidence of peritoneal spread at the first recurrence among the cytology-positive group (62.5%) was significantly higher than that among the cytology-negative group (12.5%) (Fisher's exact test, P = 0.021). Conclusion: The presence of positive peritoneal cytology appears to be an independent prognostic risk factor in patients with cervical adenocarcinoma.