Risk factors for poor prognosis in microinvasive adenocarcinoma of the uterine cervix (IA1 and IA2): A pooled analysis

ObjectiveTo identify adverse risk factors for FIGO IA1 and IA2 cervical adenocarcinoma.MethodsPubMed was used to identify all microinvasive adenocarcinoma cases. Case specific data pooled for 35 “high risk” microinvasive adenocarcinoma (MIAC), defined as cases with lymph node or lymphovascular space involvement, positive surgical margins, or recurrence was compared with 478 “low risk” cases abstracted from the SEER database (1988-1997). Statistical methods included non-paired t and Fisher's Exact tests.ResultsSurvival for 1A1 and 1A2 MIAC is 99% and 98%, respectively. Significantly more 1A2 patients underwent aggressive radical surgery and received postoperative treatment. Parametrial involvement was rare (1/373 cases). Significantly more “high-risk” cases were of endometrioid histology (6/34 vs. 14/478, p = 0.001), whereas adenocarcinoma (p = 0.046) and mucinous (p = 0.021) tumors were observed in the “low-risk” group. Among the “high-risk” cases with at least 5 years follow-up, 1.4% has recurred or died.ConclusionsEndometrioid histology may be associated with late recurrence and worse survival in stage 1A1 and 1A2 MIAC.

Research Highlights► Stage 1A1 and 1A2 MIAC has excellent survival, but is associated with remote recurrence. ► Parametria and ovarian metastasis are rare for Stage 1A MIAC. ► Significantly more 'high risk' cases are associated with endometrioid histology.