Survival of women with microinvasive adenocarcinoma of the cervix is not improved by radical surgery

• Published in: American journal of obstetrics and gynecology Vol. 217; no. 3; pp. 332.e1 - 332.e6
• Main Authors: Bean, Lisa M., MD, Ward, Kristy K., MD, Plaxe, Steven C., MD, McHale, Michael T., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017
• Subjects: adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; cervical cancer; cervix; Female; Humans; Hysterectomy; lymph node dissection; Lymph Node Excision; lymphadenectomy; Lymphatic Metastasis; microinvasive; Neoplasm Invasiveness; Obstetrics and Gynecology; Retrospective Studies; SEER Program; squamous cell carcinoma; survival; United States - epidemiology; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; microinvasive; cervix; survival; adenocarcinoma; lymph node dissection; cervical cancer; lymphadenectomy; squamous cell carcinoma
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2017.05.021

Background Treatment for early-invasive adenocarcinoma of the cervix remains controversial. Although data have shown similar survival rates to those seen with squamous cell carcinoma, conservative options for patients with microinvasive adenocarcinoma have not been as widely accepted. Despite comparable survival outcomes, patients with early-invasive adenocarcinoma are still routinely subjected to more radical surgical techniques than their equivalently staged squamous cell counterparts. Objective The objective of the study was to evaluate how less radical surgery has an impact on 5 year survival in patients with microinvasive adenocarcinoma of the cervix. Study Design The Surveillance, Epidemiology, and End Results database was queried from 1988 through 2010 to perform a retrospective analysis of women with International Federation of Gynecology and Obstetrics stage IA1 or IA2 cervical carcinoma. Five year survival by procedure type (local excision, simple hysterectomy, or radical hysterectomy) was determined for each cell type (squamous or adenocarcinoma), as was lymph node status. Results Among 1567 patients with cervical adenocarcinoma, 5 year survival was 97.3% (confidence interval, 95.8–98.2%) for stage IA1 disease and 98.3% (confidence interval, 96.5%, 99.2%) for stage IA2. For comparison, the 5-year survival rates for 5,749 patients with stage IAI or lA2 squamous cell carcinoma were 96.7% (confidence interval, 96.0–97.3%) and 95.6% (confidence interval, 94.4–96.5%), respectively. There was no statistical difference in survival between patients having either cell type undergoing local excision ( P  = .26), simple hysterectomy ( P  = .08), or radical hysterectomy ( P  = .87). We also found no statistically significant difference in survival among patients with adenocarcinoma compared by treatment type (local excision compared with simple hysterectomy [ P  = .64]; local excision compared with radical hysterectomy [ P  = .82]; or simple hysterectomy compared with radical hysterectomy [ P  = .70]). Among patients with adenocarcinoma, 0.97% had positive pelvic lymph nodes, none had positive aortic lymph nodes, and 91.85% had confirmed negative lymph nodes. For squamous cell carcinoma, 0.72% of patients had positive pelvic lymph nodes and 0.10% had positive aortic lymph nodes. Conclusion There was no significant difference in survival when patients were compared by cell type or procedure, suggesting that survival of patients with microinvasive adenocarcinoma is not improved by utilizing more invasive surgical methods. Regardless of histology, the frequency of nodal involvement was very low among both groups, supporting an overall excellent prognosis for all patients with microinvasive disease. We submit these data as evidence that preoperative planning of more conservative techniques is appropriate, not just for those with squamous histology or who desire future fertility but also for all patients with microinvasive cervical disease.