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Early Cervical Adenocarcinoma: Selection Criteria for Radical Surgery

From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, and the Department of Pathology, Brigham and Women’s Hospital; the Department of Biostatistics, Dana-Farber Cancer Institute; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.

Address reprint requests to: John O. Schorge, MD Division of Gynecologic Oncology Department of Obstetrics, Gynecology, and Reproductive Biology Brigham and Women’s Hospital 75 Francis Street Boston, MA 02115 E-mail: joschorge{at}bics.bivh.harvard.edu

Objective: To identify selection criteria for radical surgery in early cervical adenocarcinoma based on pretreatment clinical stage and correlation with high-risk surgical-pathologic factors.

Methods: One hundred seventy-five women with International Federation of Gynecology and Obstetrics (FIGO) clinical stage IB₁ (n = 132) and IB₂-IIA (n = 43) cervical adenocarcinoma were treated primarily at our institutions from 1982 to 1996. Histopathologic sections were reviewed by a gynecologic pathologist. Medical records were reviewed retrospectively and clinical follow-up was done.

Results: The overall 5-year survival rate was 87% (95% confidence interval [CI] 81%, 93%) for stage IB₁ and 61% (95% CI 46%, 77%) for stage IB₂-IIA (P < .001). Adenosquamous cell type, deep cervical invasion, and lymph-vascular space invasion were significant independent high-risk surgical-pathologic factors that affected disease-free survival (each P < .002). One hundred fourteen (86%) of 132 stage IB₁ patients and 19 (44%) of 43 stage IB₂-IIA subjects were treated primarily with radical surgery. Lymph node metastases, lymph-vascular space invasion, adenosquamous cell type, deep cervical invasion, and positive surgical margins were more than twice as frequent in stage IB₂-IIA patients who had radical surgery than in stage IB₁ patients (each P < .05). Based on high-risk surgical-pathologic factors in 133 subjects who had radical surgery, postoperative radiotherapy was recommended for 18 (16%) of 114 stage IB₁ patients and 18 (95%) of 19 stage IB₂-IIA subjects (P < .001).

Conclusion: Radical surgery for FIGO clinical stage IB₁ cervical adenocarcinoma and primary radiotherapy for stage IB₂-IIA disease would largely avoid combined-modality therapy, thereby reducing treatment-related toxicity and cost.

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