Population-Based Study of Microinvasive Adenocarcinoma of the Uterine Cervix

Abstract

In Brief Objective To analyze lymph node status and survival rates of women with microinvasive cervical adenocarcinoma (International Federation of Gynecology and Obstetrics stages IA1 and IA2). Methods The Surveillance, Epidemiology, and End Results (SEER) Public-Use Database was used to identify cases of microinvasive cervical adenocarcinoma diagnosed between 1988 and 1997. Variables analyzed included stage, extent of surgery, lymph node status, radiation therapy, and age. Statistics included analysis of trends, analysis of variance, log-rank test, one-sided binomial confidence interval estimation, and power analysis. Results Among 301 reported cases, 131 had stage IA1 and170 IA2 disease. Simple hysterectomies were done in 54 women with IA1 and 64 with IA2 disease and radical hysterectomies were done in 50 and 83 women, respectively. Only one of 140 women who had lymphadenectomy had a single positive lymph node. There were four tumor-related deaths (one with IA1, and three with IA2 disease). There were no deaths among 96 women (47, IA1; 49, IA2) treated by simple hysterectomy alone. The mean follow-up was 46.5 months (range 1–119). The censored survival rate was 98.7% overall (99.2% IA1, 98.2% IA2). Power analysis estimated that 720 patients would be required in each group to detect a 2% difference in survival. Using one-sided 95% confidence interval estimations, the risk-adverse events rate for IA1 was no more than 3.57%, and 4.50% for IA2 disease. Conclusion Prognosis is excellent for microinvasive adenocarcinoma of the uterine cervix. In 96 cases (31.9%), simple hysterectomy alone proved adequate. Microinvasive cervical adenocarcinoma has an excellent prognosis if adequately treated; in select cases (stage IA1), simple hysterectomy is probably sufficient.