An occult invasive cervical cancer found after a simple hysterectomy: a ten-year experience in a single institution

Abstract

Objective: The aims of this study were to identify patients who are at risk of a recurrence and need adjuvant treatment by risk grouping in invasive cervical cancer after a simple hysterectomy (SH).

Methods: During 2000-2009, twenty-six patients, who underwent SH and were finally diagnosed with stages higher than 1A1, were reviewed retrospectively. The American Joint Committee on Cancer (AJCC) the pathologic staging system was adopted. Based on the pathology findings, the criteria for risk scoring was set: 1 for 3mm < depth of invasion (DOI) ≤ 5mm and 2 for DOI > 5mm; 1 for 0.7mm<longest diameter (LD) ≤ 20mm and 2 for LD > 20mm; 1 for lymphovascular space invasion positive; and 3 each for parametrium, resection margin and lymph node positive. The final score was calculated by summing up the risk scores. The receiver operation characteristic (ROC) curve was created to confirm the best cut-off value.

Results: All patients were stage IA2-IB2, of which, the number of patients in stages IA2, IB1 and IB2 were 1, 24, and 1, respectively. Eleven patients did not receive any further treatment. Of the remaining 15 patients, 11 received radiation therapy (RT), 3 underwent concurrent chemoradiation therapy (CCRT), and 1 received chemotherapy alone. No patient underwent a radical parametrectomy. During a median follow-up of 67 months (range 9-122 months), 3 patients (11.5%) showed a recurrence. Patient whose score was 1-3, 4-5, and ≥6 was classified into low-risk, intermediate-risk, and high-risk group, respectively. All patients in low-risk group did not recur without any adjuvant treatment (sensitivity 100%; specificity 34.8-65.2%).

Conclusion: Adjuvant treatment can be omitted in low-risk group patients with invasive cervical cancer detected after SH.

Keywords: cervical cancer, simple hysterectomy, adjuvant treatment, risk scoring system.