ABSTRACT
OBJECTIVE: To examine characteristics and survival outcomes of women with surgically-treated cervical cancer exhibiting uterine corpus tumor invasion. METHODS: We utilized The Surveillance, Epidemiology, and End Results Program to identify cervical cancer patients who underwent hysterectomy between 1973 and 2003. Logistic regression models were used to identify risk factors for uterine corpus tumor invasion on multivariable analysis. Association of uterine corpus tumor invasion and cause-specific survival (CSS) from cervical cancer was examined with Cox proportional hazard regression models on multivariable analysis. RESULTS: We identified 837 (4.9%) cases of uterine corpus invasion and 16,237 (95.1%) cases of non-invasion. Median follow-up time was 14.0 years. There were 1642 deaths due to cervical cancer. Uterine corpus invasion was independently associated with older age, non-squamous histology, high-grade tumors, large tumor size, and nodal metastasis on multivariable analysis (all, P < 0.001). On univariable analysis, uterine corpus tumor invasion was significantly associated with decreased CSS compared to the non-invasion (5-year rates, 79.0% versus 94.5%, P < 0.001). After controlling for other significant prognostic factors, uterine corpus tumor invasion remained an independent prognostic factor for decreased CSS (adjusted-hazard ratio 1.45, 95% confidence interval 1.21-1.74). Among stage T1b cases (n = 6730), uterine corpus tumor invasion remained an independent prognostic factor for decreased CSS (adjusted-hazard ratio 1.95, 95%CI 1.47-2.60). Uterine corpus tumor invasion was significantly associated with decreased CSS in stage T1b1 disease (74.5% versus 90.7%, P < 0.001) and in stage T1b2 disease (67.0% versus 79.5%, P = 0.01). CONCLUSION: Uterine corpus tumor invasion is an independent prognostic factor for decreased survival of women with early-stage cervical cancer.
Subject(s)
Adenocarcinoma/pathology , Carcinoma, Adenosquamous/pathology , Carcinoma, Squamous Cell/pathology , Lymph Nodes/pathology , Uterine Cervical Neoplasms/pathology , Adenocarcinoma/mortality , Adenocarcinoma/therapy , Adult , Black or African American/statistics & numerical data , Brachytherapy , Carcinoma, Adenosquamous/mortality , Carcinoma, Adenosquamous/therapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/therapy , Female , Hispanic or Latino/statistics & numerical data , Humans , Hysterectomy , Kaplan-Meier Estimate , Logistic Models , Middle Aged , Multivariate Analysis , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Proportional Hazards Models , Radiotherapy, Adjuvant , SEER Program , Survival Rate , United States , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/therapy , Uterus/pathology , White People/statistics & numerical dataABSTRACT
BACKGROUND: The influence of adenomyomectomy on subsequent pregnancy is unknown. Placenta accreta is most often associated with placenta previa in women with multiple previous cesarean sections. CASE: A 41-year-old woman became pregnant six years after a laparoscopic uterine posterior adenomyomectomy. She was diagnosed with complete placenta previa and considered at a low risk for placenta accreta by ultrasonography. Cesarean section and subsequent hysterectomy were required, and histopathological analysis revealed a posterior placenta accreta. DISCUSSION: The authors discuss the association of adenomyomectomy and placenta accreta on subsequent pregnancy and conclude that previous adenomyomectomy may increase the risk of abnormal placentation. Therefore, careful treatment is required during the pregnancies of patients with previous adenomyomectomy.
