Stage I adenocarcinoma of the cervix: does lesion size affect treatment options and prognosis?

Impact of various treatment modalities on the outcome of stage IB1-IIA cervical adenocarcinoma

OBJECTIVE

To evaluate the outcomes of patients with stage IB1-IIA cervical adenocarcinoma treated by various modalities in order to formulate a better treatment strategy.

METHODS

The impact of various treatment modalities on the prognosis of 258 patients with stage IB1-IIA cervical adenocarcinoma was investigated. The therapeutic modalities included radical surgery (n=174); radical surgery followed by adjuvant radiation therapy (RT), such as RT alone or concurrent chemo-radiotherapy (CCRT) (n=46); or primary RT or CCRT (n=38).

RESULTS

As compared with patients in the surgery-only group, patients with 1 postoperative major risk who underwent surgery followed by RT or CCRT had a significantly higher likelihood of disease relapse (2.3-fold, P=0.041) and disease-related death (2.9-fold, P=0.014). The likelihood of recurrence (P=0.32) and death (P=0.58) did not differ between patients who underwent adjuvant RT or CCRT for 1 major risk factor and those who underwent primary RT or CCRT. By contrast, patients with more than 1 major risk factor had a higher likelihood of disease recurrence (2.9-fold, P=0.037) and disease-related death (3.4-fold, P=0.051) than those who underwent primary RT or CCRT.

CONCLUSION

Radical surgery is recommended for patients with stage IB1-IIA cervical adenocarcinomas without contraindications. Those with more than 1 postoperative pathologic risk factor had the worst prognosis despite adjuvant RT or CCRT.

Prognostic factors and clinicopathologic characteristics of invasive adenocarcinoma of the uterine cervix

OBJECTIVE

The purpose of this study was to evaluate the outcome of patients with cervical adenocarcinoma and to determine the characteristics and the prognostic factors of this entity.

STUDY DESIGN

This retrospective study was done in the Department of Surgical Oncology of the Salah Azaiz Institute of Tunis with 79 cases of invasive adenocarcinoma of the uterine cervix that were collected from 1990 to 1999. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors.

RESULTS

Mean age was 50 years, and metrorrhagia was mostly revealing in 73% of the cases. Early stages (I, IIa, IIb with 1/3 proximal parametrial invasion) and "pure" type adenocarcinoma were found in 78% and 87% of the cases, respectively. Treatment consisted of a radiosurgical combination in 52 cases; exclusive radiotherapy was practiced with 17 patients. The 5 year-overall and disease-free survival percentages were, respectively, 68% and 72.4%. Poor prognostic factors were age >50 years, tumor size >4 cm, advanced stage, tumor grade, and lymph nodes and lymph-vascular space involvement. With the use of multivariate analysis, only stage and lymph node metastases remained significant prognostic factors.

CONCLUSION

This report shows survival and prognostic factors that are similar to those found in previous studies, but unlike the Western countries, our results demonstrate a high rate of early stages and no increase in frequency of cervical adenocarcinoma.

[Adenocarcinoma of the cervix uteri: a retrospective study of 83 cases]

The frequency of the adenocarcinoma of cervix uteri is increasing.

AIM OF THE STUDY

To define the characteristics of the entity.

PATIENTS AND METHODS

Between 1986 and 1992, 83 adenocarcinoma of cervix uteri, were treated at the Ibn Rochd Oncology Centre in Casablanca. It's a retrospective study with univariate analysis of the prognostic factors. This analysis was done for patients who were followed until the death or have 5 years or more follow up and the survival was calculated according the Kaplan & Meier method at 5 years. The local and regional recurrence factors were evaluated statically according the chi 2 and those for survival rate according the Logrank test.

RESULTS

The frequency increased during the period with 2.1% in 1986 and 8.2% in 1992. The median of aged was 49 years. Fifty one patients have localised stage. Combined radiotherapy and surgery was performed in 66 cases and 17 received radiation alone. The loco-regional control was obtained in 83% among 73 available patients for results. The univariate analysis showed that the histological type was not a significant factor. However, age, tumor size, stage, histological grade and lymph node involvement were significant factors. These factors, the degree of differentiation and the lymph node involvement were significant for the 5-years survival.

CONCLUSION

The prognosis factors of the cervix uteri adenocarcinoma are, size tumor more than 4 cm, lymph node involvement, microscopic involvement to the parameters and positives excision merges.