Peritoneal cytology and preoperative serum CA 125 level are important prognostic indicators of overall survival in advanced endometrial cancer

Background: The current study aimed to evaluate flow cytometry findings, peritoneal cytology and preoperative CA 125 level as prognostic factors of endometrial carcinoma. Patients and Methods: A retrospective study of 44 patients with FIGO stage II-IV endometrial carcinoma who underwent abdominal hysterectomy, bilateral salpingo-oophorectomy and, all except three, pelvic lymph node dissection. At operation, a peritoneal washing sample was taken for cytological examination. Flow cytometry was performed on fresh primary tumor samples. Blood samples were obtained within 2 weeks before surgery. The median follow-up time was 54 months. Results: In univariate analysis, DNA ploidy, S-phase fraction, serum CA 125 level and peritoneal cytological findings correlated significantly with survival. In multivariate analysis, peritoneal cytology (benign versus malignant), grade (1+2 versus 3) and preoperative serum CA 125 concentration (less than or equal to 25 U/ml versus > 25 U/ml) remained significant independent predictors of overall survival. DNA ploidy and S-phase fraction had a strong correlation with peritoneal cytology. Malignant cytological findings were more frequent in cases with DNA aneuploidy and S-phase fraction higher than 8%. Conclusion: In addition to histological grade, peritoneal cytology and preoperative serum CA 125 level were also important independent prognostic indicators of outcome.