title: Influence of positive peritoneal cytology on prognostic factors and survival in early-stage endometrial cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The prognostic significance of positive peritoneal cytology in patients with early-stage endometrial cancer (Stage 1 or 2) is controversial and perhaps depends on the presence of other factors. The relationship of other prognostic factors with positive peritoneal cytology remains unclear. This study aimed to investigate the association between positive peritoneal cytology and prognostic factors and the influence of positive peritoneal cytology on survival in patients with early-stage endometrial cancer.
  
  
  METHODS
  We identified 351 articles on the PubMed, Cochrane and Embase databases using a combination of the following search terms: endometrial cancer, endometrial carcinoma, positive peritoneal cytology and positive peritoneal washing. When filtered for studies comparing positive peritoneal cytology with negative peritoneal cytology in early-stage endometrial cancer, 11 retrospective studies met the selection criteria. Meta-analyses were performed using Review Manager 5.3 software.
  
  
  RESULTS
  In patients with surgical stage 1 or 2 early-stage endometrial cancer, the incidence of Grade 3 was higher and 5-year overall survival was worse in patients with positive peritoneal cytology compared with negative peritoneal cytology. However, the incidence of Grade 1 was lower in those with positive peritoneal cytology compared with negative peritoneal cytology. In patients with surgical stage 1 early-stage endometrial cancer, the incidence of myometrial invasion ≥1/2 tended to be higher and 5-year progression-free survival was worse in the positive peritoneal cytology group than the negative peritoneal cytology group. However, the incidence of myometrial invasion <1/2 was lower in the positive peritoneal cytology group than the negative peritoneal cytology group.
  
  
  CONCLUSIONS
  This study demonstrates that positive peritoneal cytology in patients with early-stage endometrial cancer is significantly associated with other prognostic factors and survival, suggesting its potential as a prognostic factor.
authors.affiliation: Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Seoul.
authors.forename: Banghyun
authors.initials: B
authors.lastname: Lee
authors.affiliation: Department Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Suh
authors.affiliation: Department Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do.
authors.forename: Kidong
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do.
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: No
authors.affiliation: Department Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do School of Medicine, Seoul National University, Seoul, Republic of Korea ybkimlh@snubh.org.
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Kim
mesh_terms: D016208:Databases, Factual; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D010537:Peritoneum / Q000166:cytology*; D011379:Prognosis; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology*
keywords: cytology; endometrial neoplasm; grade; prognosis; survival