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Background <p>The prognostic role of positive peritoneal cytology (PPC) in early stage endometrial cancer remains debated. Although cytology was removed from the FIGO staging system in 2009, recent studies suggest that it may still carry independent prognostic value.</p> Methods <p>A literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2005 and 2025. Eligible studies included patients with FIGO stage I–II disease who had peritoneal cytology performed at primary surgery and reported survival outcomes.</p> Results <p>Ten retrospective cohort studies published between 2006 and 2023 were included, involving more than 17,000 patients from single center, multicenter, and population based datasets. The prevalence of PPC in early-stage cohorts ranged approximately from 3% to 14%. Across studies, PPC was consistently associated with adverse pathological features such as high-grade tumors, deep myometrial invasion, and lymphovascular space invasion. Large population-based analyses showed that PPC independently predicted worse overall and disease-free survival. The effect was most pronounced in high grade and non-endometrioid tumors.</p> Conclusion <p>Although PPC is no longer part of the FIGO staging system, data from large cohorts suggest that it may still carry prognostic weight in early stage endometrial cancer. While results are not universally consistent, the available evidence warrants clinical attention. Prospective, multi institutional studies with standardized cytology reporting are needed to clarify its prognostic role and to determine whether PPC should influence staging or adjuvant treatment decisions.</p>

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Positive Peritoneal Cytology in Early-Stage Endometrial Cancer: What Recent Evidence Tells Us

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Cem Yagmur Ozdemir,
  • Nayif Çiçekli,
  • Dagistan Tolga Arioz,
  • Bahar Marangoz

摘要

Background

The prognostic role of positive peritoneal cytology (PPC) in early stage endometrial cancer remains debated. Although cytology was removed from the FIGO staging system in 2009, recent studies suggest that it may still carry independent prognostic value.

Methods

A literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2005 and 2025. Eligible studies included patients with FIGO stage I–II disease who had peritoneal cytology performed at primary surgery and reported survival outcomes.

Results

Ten retrospective cohort studies published between 2006 and 2023 were included, involving more than 17,000 patients from single center, multicenter, and population based datasets. The prevalence of PPC in early-stage cohorts ranged approximately from 3% to 14%. Across studies, PPC was consistently associated with adverse pathological features such as high-grade tumors, deep myometrial invasion, and lymphovascular space invasion. Large population-based analyses showed that PPC independently predicted worse overall and disease-free survival. The effect was most pronounced in high grade and non-endometrioid tumors.

Conclusion

Although PPC is no longer part of the FIGO staging system, data from large cohorts suggest that it may still carry prognostic weight in early stage endometrial cancer. While results are not universally consistent, the available evidence warrants clinical attention. Prospective, multi institutional studies with standardized cytology reporting are needed to clarify its prognostic role and to determine whether PPC should influence staging or adjuvant treatment decisions.