重视腹水/腹腔冲洗液细胞学检查在子宫内膜癌诊治中的规范应用  

Call for the standardized application of ascites/peritoneal flushing fluid cytology in the diagnosis and treatment of endometrial cancer

作　　者：张师前[1] 孔文志 Zhang Shiqian;Kong Wenzhi(Department of Obstetrics and Gynaecology,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]山东大学齐鲁医院妇产科,济南250012 [2]首都医科大学附属北京妇产医院/北京妇幼保健院妇瘤科,北京100006

出　　处：《中华医学杂志》2025年第8期578-583,共6页National Medical Journal of China

摘　　要：子宫内膜癌(EC)的国际妇产科联盟(FIGO)分期标准由预后相关的多项临床病理学因素构成,目的在于协助预判预后、指导规范化治疗。虽然FIGO 2009版分期将腹水/腹腔冲洗液细胞学这一因素排除在外,但其重要性仍存争议。本文详细分析了目前腹水/腹腔冲洗液细胞学送检中所面临的问题,并从不同患者人群中深入探讨了腹水/腹腔冲洗液细胞学阳性(PAC/PPC)与EC预后之间的关系,包括不同分期、不同组织学类型、不同风险分层及不同分子分型的患者,并最终得出PPC影响患者预后的结论。因此,笔者基于目前的证据,呼吁送检腹水/腹腔冲洗液细胞学仍然是EC分期手术必要的、不可或缺的步骤。临床工作中应重视腹水细胞学的送检,提高EC细胞学检测的精准度、"可信度"及送检率,至于是否需要更为激进的治疗方式,仍需要大样本前瞻性研究予以证实。The International Federation of Gynecology and Obstetrics(FIGO)staging system for endometrial cancer(EC)integrates various clinicopathological factors associated with EC prognosis to aid in prognosis prediction and treatment guidance.Although the 2009 FIGO staging criteria excluded ascites/peritoneal flushing fluid cytology,the importance of this factor remains controversial.This review thoroughly analyzed the current problems in ascites/peritoneal flushing fluid cytology sample submission and investigates the association between positive ascites/peritoneal flushing fluid cytology(PAC/PPC)and EC prognosis across different patient groups,including various stages,histological types,risk stratifications,and molecular subtypes.The findings demonstrated that PPC significantly impacted patient prognosis.Therefore,based on current evidence,the author advocates for the continued submission of ascites/peritoneal flushing fluid cytology as a crucial and indispensable step in the surgical staging of EC.In clinical practice,emphasis should be placed on the accuracy,reliability,and submission rate of EC cytology testing.The necessity for more aggressive treatment approaches requires the validation through large-scale prospective studies.

关 键 词：癌 子宫内膜样 腹水/腹腔冲洗液细胞学 预后 分期 

分 类 号：R737.33[医药卫生—肿瘤]