An Occult Invasive Cervical Cancer Found After a Simple Hysterectomy: A 10-Year Experience in a Single Institution

Abstract

ObjectiveThe aim of this study was to identify patients who are at risk of a recurrence and those needing adjuvant treatment by risk grouping in invasive cervical cancer after a simple hysterectomy (SH).MethodsDuring 2000–2009, 26 patients who underwent SH and were finally diagnosed with stages higher than IA1 were reviewed retrospectively. The American Joint Committee on Cancer (AJCC) pathologic staging system was adopted. Based on the pathologic findings, the criteria for risk scoring was set: 1 for depth of invasion (DOI) is between 3–5 mm, and 2 for DOI greater than 5 mm; 1 for longest diameter (LD) is between 0.7–20 mm, and 2 for LD greater than 20 mm; 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 curve was created to confirm the best cutoff value.ResultsAll patients were stage IA2 to 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, 3 underwent concurrent chemoradiation therapy, 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 to 3, 4 to 5, and 6 or higher was classified into low-risk, intermediate-risk, and high-risk groups, respectively. All patients in the low-risk group did not recur without any adjuvant treatment (sensitivity, 100%; specificity 34.8–65.2%).ConclusionsAdjuvant treatment can be omitted in low-risk group patients with invasive cervical cancer detected after SH.