Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China

Abstract

ObjectiveTo explore appropriate treatment modality of microinvasive cervical cancer (MIC) and to analyze prognosis and risk factors of recurrence.MethodsA cohort of 324 Chinese patients with MIC diagnosed and treated at Peking Union Medical College Hospital was retrospectively reviewed. Demographic features, treatment modalities, pathologic parameters, risk factors of residual disease, survival and risk factors of recurrence were analyzed.ResultsOf all patients, 280 cases were staged IA1 and 44 cases staged IA2 MIC. Twenty-five cases (7.7%) were found to have lympho-vascular space involvement (LVSI), but no parametrial involvement or ovarian metastasis was detected. Only one staged IA2 patient with LVSI was found to have lymph node metastasis. 32.4% patients (82/253) had residual diseases after conization. No significant difference of LVSI, lymph node metastasis and residual disease after coniztion was found between stage IA1 and IA2 MIC patients. Multivariate logistic analysis showed positive margin was the only independent risk factor of residual disease after conization (odds ratio [OR], 4.18; p<0.001). Recurrence occurred in five cases, but no mortality was found. Progression-free survival for stage IA1 patients treated by conization or hysterectomy was similar (92.3% and 98.8%, p=0.07). Cox regression analysis revealed LVSI as an independent risk factor for recurrence in stage IA1 patients (OR, 12.14; p=0.01).ConclusionFor stage IA1 patients with negative resection margin and no LVSI, conization can be an ideal treatment modality. For stage IA2 patients, more conservative surgery such as simple hysterectomy may be considered. LVSI is an independent risk factor for recurrence in patients with stage IA1 cervical cancer.

Prognostic significance of lymphovascular space invasion for stage IA1 and IA2 cervical cancer

“…Creasman et al in 1985 reported LVSI in a cohort of stage IA cervical cancers that was intermediate: 10.8% for stage IA1 and 33.3% for stage IA2 6. Most recent studies cite LVSI positivity under 8% for stage IA1 disease and anywhere from 11.4% to 33.3% for stage IA2 disease 8–11 13 14. In our cohort, LVSI positivity was seen in 10.5% of those with stage IA1 disease and 18.8% of those with stage IA2 disease, which falls within the range of prevalence previously described.…”

“…Prior studies of women with microinvasive cervical cancer have reported LVSI rates of 2.8%–21.6% 4–14. In 1979, Sedlis and colleagues observed LVSI in 19.6% of patients with ‘microinvasive carcinoma’ with a depth of invasion <3 mm and in 43% of cases with depth of invasion 3–5 mm, corresponding to contemporary stage IA1 and IA2 disease 3.…”

“…LVSI is defined as the presence of malignant cells within endothelial-lined vascular or lymphatic spaces outside of the primary invasive tumor. LVSI is identified in 3%–22% of stage IA1 cervical cancers4–11 and 11%–43% of stage IA2 cervical cancers 4–7 11–14. LVSI is considered a high-risk pathologic characteristic and has been associated with lymph node metastases for women with early-stage disease 6 14.…”

Analysis of Conservative Surgical Treatment and Prognosis of Microinvasive Squamous Cell Carcinoma of the Cervix Stage IA1: Results of Follow-Up to 20 Years

“…11Y13 Treatment plan for MIC without LVSI should also consider the risk of invasive disease in the residual cervix and risk of recurrence, and the most important parameters to define treatment extension and prognosis in those cases are depth of stromal invasion, conization margin involvement, and residual disease after cervical conization. 9,14Y16 Although it has been suggested by several retrospective studies that MIC has excellent prognosis and less radical surgery could be considered for these cases, 3,8,9,16 data regarding the risk and extent of residual disease in these settings are not uniform at this time. In the present study, we report a cohort of 139 women with MIC without LVSI treated conservatively or not and followed up to 20 years to explore appropriate treatment modality and analyze the prognosis and risk factors for recurrence.…”

Fertility-Sparing Surgery In Early Stage Cervical Cancer

“…24 Lymphovascular space involvement is rare in stage IA1, and its presence does not affect FIGO stage, though it is said to be a risk factor for recurrence. 9,40 To date, the impact of LVSI on the prognosis of micorinvasive carcinomas is controversial. 9 In some centers, patients with stage IA1 cancer that show positive LVSI from diagnostic conization, definitive conization is carried out preceded by lymphadenectomy; nodal involvement is confirmed with frozen section.…”