Objective This study aimed to examine the correlation between malignant peritoneal cytology and overall survival among patients with uterine leiomyosarcoma and endometrial stromal sarcoma.
Methods Patients with uterine leiomyosarcoma and endometrial stromal sarcoma between January 2010 and December 2016 were identified from the Surveillance, Epidemiology, and End Results database. The multiple imputation method was used to address missing values. Propensity score matching was conducted to balance baseline data between the malignant and negative peritoneal cytology groups. The prognostic significance of malignant peritoneal cytology was evaluated using Cox regression, random survival forest, and subgroup analyses.
Results Among 733 eligible patients, 8% (59/733) had malignant peritoneal cytology, increasing to 20% (42/209) in advanced cases. Before and after propensity score matching, patients with malignant peritoneal cytology had significantly lower 5-year overall survival rates and shorter median survival time than patients with negative peritoneal cytology. Multivariate Cox regression revealed that malignant peritoneal cytology (hazard ratio 2.03, 95% confidence interval 1.29 to 3.20, p=0.002) was an independent prognostic factor for uterine leiomyosarcoma and endometrial stromal sarcoma. Random survival forest further indicated that, among the factors analyzed, peritoneal cytology status was second only to the International Federation of Gynecology and Obstetrics (FIGO) stage in terms of prognostic prediction. Finally, subgroup analyses substantiated the correlation between malignant peritoneal cytology and unfavorable overall survival in most subgroups.
Conclusions Malignant peritoneal cytology status was an important prognostic factor complementing FIGO stage and was associated with a reduction in overall survival. Peritoneal cytology evaluation during hysterectomy may be recommended for prognosis estimation for uterine leiomyosarcoma and endometrial stromal sarcoma.
- uterine cancer
Data availability statement
Data are available in a public, open access repository. The data that support the ﬁndings of this study are openly available in the National Cancer Institute’s SEER program (https://seer.cancer.gov/).
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Contributors JD: conceptualization, methodology, statistical analyses, and writing–original draft. DH: data acquisition and methodology. YX: writing–original draft. RH: writing–review and editing. YC: software and statistical analyses. HL: methodology and writing–review and editing. CL: conceptualization and supervision. XL and YY: writing–review and editing. Guarantor of the manuscript: YY. All authors have contributed to the study conception and approved the submitted version of the manuscript.
Funding This research was supported by the National Natural Science Foundation of China (No 81960278), the Gansu Provincial Science and Technology Project-Youth Science and Technology Fund (No 20JR5RA371), the Gansu Provincial Science and Technology Project-Youth Science and Technology Fund (No 21JR7RA383), and the Intra-Hospital Funds of the First Hospital of Lanzhou University (No ldyyyn2021-2).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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