Article Text

Download PDFPDF
Patterns and risk factors of recurrence in low-risk early-stage cervical adenocarcinoma treated with surgery alone: implications on risk group stratification
  1. Bong Kyung Bae1,
  2. Won Kyung Cho1,
  3. Byoung-Gie Kim2,
  4. Chel Hun Choi2,
  5. Tae-Joong Kim2,
  6. Yoo-Young Lee2,
  7. Jeong-Won Lee2 and
  8. Won Park1
  1. 1Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  2. 2Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Won Park, Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of); wonro.park{at}samsung.com; Dr Jeong-Won Lee, Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of); garden.lee{at}samsung.com

Abstract

Objective Cervical adenocarcinoma has poorer outcomes compared with squamous cell carcinoma; however, treatment is identical irrespective of histologic sub-types. This study aimed to investigate the patterns and risk factors of recurrence following surgery alone for low-risk early-stage cervical adenocarcinoma.

Methods We retrospectively reviewed patients who underwent surgery alone for low-risk early-stage cervical adenocarcinoma between January 2001 and December 2018 in a single institution. Baseline clinicopathological characteristics were collected to identify the factors associated with recurrence-free survival.

Results A total of 252 patients met the inclusion criteria. Most patients underwent radical hysterectomy (218 patients, 86.5%) and had usual type endocervical adenocarcinoma (190 patients, 75.4%). The International Federation of Gynecology and Obstetrics 2018 stage was IA1 in 72 patients (27.4%), IA2 in 58 (22.1%), IB1 in 51 (19.4%), and IB2 in 71 patients (27.0%). With a median follow-up of 70.4 months (range 6.2–252.5 months), 5-year survival rates were as follows: locoregional recurrence-free survival, 93.0%; recurrence-free survival, 89.6%; overall survival, 94.7%. The recurrence patterns were local in nine patients (32.1%), regional in five patients (17.8%), distant in 10 patients (35.7%), local and distant in one patient (3.6%), regional and distant in two patients (7.2%), and locoregional and distant in one patient (3.6%). In multivariable analysis, negative human papillomavirus (HPV) status (HR 7.314; p<0.001) and deep cervical stromal invasion (HR 5.110; p=0.003) were associated with poor locoregional recurrence-free survival. Patients were stratified based on the number of risk factors and a statistically significant difference in locoregional recurrence-free survival was observed: 5-year survival rates of 99.0%, 84.2%, and 50.0% for patients with 0, 1, and 2 risk factors (0 vs 1, p=0.001; 1 vs 2, p=0.011).

Conclusion Surgery alone for low-risk early-stage cervical adenocarcinoma was associated with favorable outcomes over a long follow-up period. Patients with the highest risk of recurrence were those with a negative HPV status and deep cervical stromal invasion. Additional management following surgery may be considered in patients with these risk factors.

  • Adenocarcinoma
  • Pathology

Data availability statement

Data are available upon reasonable request.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text

Footnotes

  • Contributors Conceptualization: WP and J-WL. Data curation: BKB, WKC, B-GK, CHC, T-JK, Y-YL, and J-WL. Formal analysis: BKB, WP and J-WL. Investigation: BKB, WP and J-WL. Methodology: BKB, WKC, WP and J-WL. Project administration: BKB, WP and J-WL. Manuscript writing – original draft: BKB, WP and J-WL. Manuscript writing – review and editing: BKB, WKC, B-GK, CHC, T-JK, Y-YL, and J-WL.

    WP and J-WL are the guarantors of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.