Prognostic impact of positive peritoneal washing cytology in surgically treated cervical cancer

Positive peritoneal washing cytology is an uncommon but potentially clinically relevant finding in cervical cancer. This retrospective cohort study evaluated its association with recurrence, survival, and metastasis-related biomarkers in patients undergoing open surgery for cervical cancer between 2018 and 2023. A total of 120 patients were classified as peritoneal washing cytology-positive (n = 32) or cytology-negative (n = 88). Baseline clinicopathological characteristics were broadly comparable between groups. Kaplan-Meier analysis demonstrated poorer survival among patients with positive cytology. The estimated 5-year overall survival was 43.7% (95% CI, 26.8-59.4%) in the cytology-positive group and 67.9% (95% CI, 55.2-77.8%) in the cytology-negative group, whereas the corresponding 5-year progression-free survival estimates were 36.5% (95% CI, 20.5-52.6%) and 62.4% (95% CI, 49.8-72.8%), respectively. Recurrence was more frequent among cytology-positive patients, particularly distant-organ recurrence. Serum VEGF and tissue MMP-9 levels were higher in the cytology-positive group. In multivariable analysis, positive peritoneal washing cytology remained associated with poorer overall survival after adjustment for selected clinicopathological variables. A combined VEGF/MMP-9 model showed exploratory discrimination for lymph-node metastasis, although the model requires internal and external validation. These findings suggest that positive peritoneal washing cytology may identify a subgroup with adverse outcomes after surgery, but prospective and externally validated studies are required before clinical application.