Survival rate of positive peritoneal cytology in endometrial cancer; a systematic review and meta-analysis

Background The impact of positive peritoneal cytology on survival rate of endometrial cancer patients in different stages and histopathology is still controversial. We performed a systematic review and meta-analysis to investigate the influence of positive peritoneal cytology (PPC) on survival rate of patients with endometrial carcinoma. Methods A systematic literature search of PubMed, Embase, Scopus, and Cochrane databases was conducted up to November 24, 2020. The quality of included studies was evaluated by Quality in prognosis study (QUIPS) tool. Results Initially, 3014 articles were found, of which 65 met the inclusion criteria for qualitative analysis and 27 studies on 75897 patients with endometrial cancer were included in the meta-analysis. PPC was associated with a lower overall survival in endometrial cancer (HR= 2.102; 95% CI:1.629-2.711; P< 0.001). The findings also identified PPC as an independent prognostic factor for both disease-free survival (HR= 3.052; 95% CI: 2.348-2967; P< 0.001) and cancer specific survival (HR= 3.461; 95% CI: 2.280-5.254; P< 0.001). In addition, we meta-analyzed the studies in 21 subgroups based on staging and histopathology of the endometrial cancer which all identified PPC as a non-prognostic factor for cancer of endometrium. Conclusion PPC is an independent prognostic factor for endometrial cancer survival rate in all staging and histopathologic subgroups.