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Analysis of Conservative Surgical Treatment and Prognosis of Microinvasive Squamous Cell Carcinoma of the Cervix Stage IA1: Results of Follow-Up to 20 Years
  1. Caio Augusto Hartman, MD,
  2. Julio Cesar Teixeira, MD, PhD,
  3. Sergio Bruno Barbosa, MD, PhD,
  4. Stephanye Mariano Figueiredo, MD,
  5. Liliana Aparecida Lucci De Angelo Andrade, MD, PhD and
  6. Joana Froes Bragança Bastos, MD, PhD
  1. * Department of Obstetrics and Gynecology, and
  2. Department of Pathology, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil.
  1. Address correspondence and reprint requests to Julio Cesar Teixeira, MD, PhD, Division of Gynecologic and Breast Oncology, Women's Health Hospital (CAISM), UNICAMP, Rua Alexander Fleming, 101 – Cidade Universitaria, Campinas, Sao Paulo13083-881, Brazil. E-mail: juliotex{at}fcm.unicamp.br; juliotex{at}uol.com.br.

Abstract

Objective The aim of this study was to evaluate the prognosis and recurrence of microinvasive squamous cervical (MIC) cancer stage IA1 in women treated conservatively or by hysterectomy, and followed-up to 20 years.

Methods It was studied in a cohort of 139 women with MIC, 41 definitively managed by conization and 98 by hysterectomy from January 1994 to December 2003 and followed-up until 2013. The definitive treatment, age, conization technique (loop electrosurgical excision procedure or cold knife conization), cone margin, residual disease in hysterectomy specimen, and the association with recurrence (intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse, and microinvasive or worse) were analyzed.

Results There were 2.5 times more conservative treatment in younger women than older (>40 years), and high proportion of residual disease in hysterectomy specimens (67% of intraepithelial cervical neoplasia grade 3 or worse), more common if positive cone margin (74% vs 35%, P < 0.002). There were 2.3% (3/133) recurrences detected as microinvasive or worse, and 6% (8/133) recurrences detected as intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse: 7.3% (3/41) in the conization group and 5.4% (5/92) in the hysterectomy group (P = 0.701). Almost all recurrences (88%, 7/8) were diagnosed until 36 months after treatment, and they were not associated with conization technique. There were no differences in risk of recurrence and overall disease-free survival time related to type of treatment.

Conclusions This study demonstrates the good prognosis of MIC, regardless the treatment. When fertility is not a concern, hysterectomy should be considered as definitive treatment to avoid the risk of residual disease. Regular follow-up for a long period should be maintained.

  • Cervical carcinoma
  • Microinvasive
  • Stage IA
  • Treatment
  • Recurrence

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Footnotes

  • The authors provided the financial support for this study.

  • The authors declare no conflicts of interest.

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