Presence of Glandular Cells at the Preoperative Cervical Cytology and Local Recurrence in Endometrial Cancer

We investigated the correlation between glandular cells (GC) detected at preoperative cervical-smear and the histologic findings and oncologic outcomes in patients undergoing surgery for endometrial cancer (EC). We retrospectively analyzed data of all consecutive EC patients who underwent surgery between January 1, 1990 and December 31, 2012 with preoperative cervical smear performed within 3 mo from the EC diagnosis. Basic descriptive, logistic regression and artificial neural network analyses were used. Five-year disease-free survival and overall survival were assessed using Kaplan-Meier and Cox hazard models. The study included 229 (89%) and 29 (11%) patients with normal cytology (control group) and GC (GC group), respectively. A higher proportion of elderly patients with nonendometrioid and FIGO grade 3 EC was observed in the GC group compared with the control group (P<0.05). No differences in 5-yr disease-free survival and overall survival were observed. However, patients in the GC group experienced a higher local recurrence rate (hazard ratio: 7.6; 95% confidence interval: 1.7–34.2; P=0.008). We observed that age, body mass index, cervical stromal invasion, vaginal brachytherapy, and GC influenced the risk for developing local recurrence. However, at the multivariable analysis, only cervical stromal invasion (odds ratio: 1.2; 95% confidence interval: 1.02–1.4; P=0.02) and GC (odds ratio: 1.07; 95% confidence interval: 1.01–1.14; P=0.03) correlated with the increased risk. In addition, the results of an artificial neural network analysis reported that the most critical predictor of local failure was cervical stromal invasion (importance: 0.352) followed by GC (importance: 0.194). These results suggest that cervical stromal invasion and presence of GC at the preoperative cervical smear might predict the occurrence of local recurrence in EC.