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

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

Am J Obstet Gynecol. 2017 May 15;:

Authors: Bean LM, Ward KK, Plaxe SC, Mchale MT

Abstract
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: To evaluate how less radical surgery impacts 5-year survival in patients with microinvasive adenocarcinoma of the cervix.
STUDY DESIGN: The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1988-2010 to perform a retrospective analysis of women with FIGO 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 1,567 patients with cervical adenocarcinoma, 5-year survival was 97.3% (CI= 95.8%, 98.2%) for stage IA1 disease and 98.3% (CI= 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% (CI= 96.0%, 97.3%) and 95.6% (CI= 94.4%, 96.5%), respectively. There was no statistical difference in survival between patients having either cell type undergoing local excision (p=0.26), simple hysterectomy (p=0.08) or radical hysterectomy (p=0.87). We also found no statistically significant difference in survival among patients with adenocarcinoma compared by treatment type [local excision compared to simple hysterectomy (p=0.64), local excision compared to radical hysterectomy (p=0.82), or simple hysterectomy compared to radical hysterectomy (p=0.70)]. 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.
CONCLUSIONS: 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 for all patients with microinvasive cervical disease.

PMID: 28522318 [PubMed - as supplied by publisher]

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