Survival Analysis of Endometrial Carcinoma : Comparison Between Normal and Abnormal Cervical Cytology

Abstract

Introduction Preoperative malignant cervical cytology has been correlated with a higher surgicopathological stage or extrauterine metastasis of endometrial carcinoma patients. No study has identified cervical cytology as an independent prognostic factor of these patients.

Objectives To compare the survival of endometrial carcinoma patients between normal and abnormal cervical cytology, and to determine the independent prognostic factors of these patients.

Study design Historical cohort study.

Methods                 We retrospectively reviewed the preoperative cervical cytology and clinicopatho-

logical findings of 122 surgically staged endometrial carcinoma patients in Songklanagarind Hospital during 1987-1998. Survival analysis was conducted using Kaplan-Meier plots and Cox proportional hazards regression model.

Results                   Ninety-four patients (77.1 %) had normal cervical cytology, and 28 patients (22.9%)

had abnormal cervical cytology. The overall 5-year survival of endometrial carcinoma patients was 76.7%. Univariate analysis of the clinicopathologic prognostic factors showed that survival was significantly poorer in patients with abnormal cervical cytology (p = 0.004). The 5-year survival of patients with norma! and abnormal cervical cytology was 83.6% and 56.8% respectively (p = 0.001). Survival was also significantly correlated with tumor stage (p < 0.001), histologic grading (p = 0.011), myometrial invasion (p - 0.003), adnexal metastasis (p < 0.001), pelvic or paraaortic lymph node metastasis (p < 0.001) and peritoneal cytology (p < 0.001). No association was found between survival and patients’ age (p = 0.085), histologic type (p = 0.482) or cervical metastasis (p = 0.388). Multivariate analysis showed that abnormal cervical cytology (p = 0.013), nodal metastasis (p = 0.009) and peritoneal cytology (p = 0.001) were significant prognostic factors.

Conciusion Endometrial carcinoma patients with abnormal cervical cytology had significantly lower survival than those with normal cytology. Preoperative cervical cytology, nodal metastasis and peritoneal cytology were the independent prognostic factors of endometrial carcinoma patients.