The role of radical hysterectomy in adenocarcinoma of the endometrium

doi:10.1016/0090-8258(74)90024-9

Gynecologic Oncology

Volume 2, Issues 2–3, August 1974, Pages 331-347

https://doi.org/10.1016/0090-8258(74)90024-9 Get rights and content

Abstract

A retrospective assessment of treatment results for patients with adenocarcinoma of the endometrium shows little progress for the past 20 yr in management of this disease. These accomplishments may have been affected adversely by the increased number of elderly patients treated within recent years, for the prognosis worsens with advanced age. Likewise, because women are living longer, more enter the age when adenocarcinoma of the endometrium is prevalent, increasing the frequency of this disease. Thus, gynecologic oncologists have become aware that the treatment problem for adenocarcinoma of the endometrium deserves more research for methods to improve survival.

The primary lesion is readily curable by hysterectomy. Therefore, it is the metastases which need better therapy. For this purpose, megavoltage irradiation therapy is being used more often to supplement intracavitary radium. However, the role of radical hysterectomy has been reconsidered.

A review of the experiences with radical hysterectomy has been summarized from the literature and the conclusions presented.

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Citation Excerpt :
In our series, we found a low complication rate among women treated with M-RAH, similar to that of patients treated with SAH. Our data is in disagreement with previous studies associating radical hysterectomy with significant morbidity [49]. Contrast-enhanced magnetic resonance imaging (MRI) may be an important tool in predicting cervical SI and triaging them to primary treatment with M-RAH.
Endometrioid adenocarcinoma of the endometrium (EEC) is the most common histologic type of endometrial cancer, with stage being the most critical prognostic factor. Cervical involvement (CI), divided into IIA (epithelial involvement) and IIB (stromal invasion), is overall associated with decreased survival (70 vs 90%). However, the impact on prognosis of sub-stages IIA vs IIB is unclear. The purpose of this study was to investigate the prognostic significance of cervical involvement as well as its substaging in patients diagnosed with EEC.
Eighty-one patients treated for stage II EEC were identified (1993–2003) in our institution. They were stratified into Group 1 (46) with available slides for review and Group 2 (35) with information obtained from the pathology report. All pathology reports, for all 81 patients, contained information on cervical glandular and stromal involvement. In Group 1, 1 to 6 slides of cervix (mean 3) were reviewed. Tumors were classified as Stage IIA or IIB according to the most recent FIGO criteria. Stromal invasion (SI) in Group 1 tumors was sub-classified in 4 subgroups based on depth of invasion; A) ≤ 1 mm; B) > 1 mm and ≤ 3 mm; C) > 3 mm and ≤ 5 mm and D) > 5 mm. Other histopathologic parameters evaluated include grade, depth of myometrial invasion (MI), and lymphovascular invasion (LI). Clinical data included age, type of surgery, type of radiation, and survival. Statistical analysis was performed.
Patients ranged in age from 33–91 (median 64) years. In Group 1, 11 patients had stage IIA and 35 stage IIB tumors. Depth of SI ranged from 1–12 mm (mean 3.4 mm). The pathologists reviewing the slides in Group 1 agreed with the initial reported description of cervical glandular and stromal involvement. In Group 2, 15 patients had stage IIA and 20 stage IIB tumors with no further information regarding depth of SI. In Group 1, 12 EECs were Grade 1, 29 Grade 2, and 5 Grade 3. Thirty tumors had < 50% MI, 15 showed > 50% MI and LVI was present in 11. In Group 2, 13 tumors were Grade 1, 13 Grade 2, and 9 Grade 3. Twenty-one had < 50% or no MI and 9 showed LVI. Median follow-up was 73 (range 5–210) months. Five- and 10-year survival rates were 83% and 78% for patients with stage IIA and 71% and 65% for stage IIB EECs respectively. By univariate analysis, age, MI, LVI and type of treatment affected survival but not substaging into IIA vs IIB or depth of SI. By multivariate analysis, only age (p = 0.001), LVI (p = 0.017), and type of treatment (p = 0.022) were predictors of survival in stage II EECs.
This study showed that the distinction between stage IIA and IIB or depth of SI does not affect survival in patients with EEC. LVI and type of hysterectomy performed were predictors of survival in stage II EECs. Our results suggest that substaging should be eliminated, women with suspect cervical SI should be offered a radical hysterectomy, and that the presence of LVI may be a useful tool in guiding recommendations about the need for adjuvant radiation therapy.

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