Novel predictors for identifying cervical minimal deviation adenocarcinoma patients with poor prognosis: a long-term observational study in a tertiary centre

Arch Gynecol Obstet. 2024 Apr;309(4):1483-1490. doi: 10.1007/s00404-023-07207-1. Epub 2023 Sep 11.

Abstract

Purpose: To elucidate the clinicopathological features and prognostic factors of minimal deviation adenocarcinoma (MDA) of the uterine cervix, a clinically rare but highly invasive disease.

Methods: This was a retrospective, observational, real-world study of 43 patients with pathologically confirmed MDA at the Obstetrics and Gynaecology Hospital of Fudan University between November 2010 and November 2021. Baseline clinicopathological data were collected and reviewed. Prognostic factors for progression-free survival (PFS) and overall survival (OS) were investigated by univariate and multivariate Cox proportional hazards analyses.

Results: Chief complaints included irregular vaginal discharge and/or bleeding (74.4%). Preoperative diagnosis was difficult, the detection rate was low (36.8%), all cases showed endophytic lesions, and 88.4% had deep stromal invasion, with biologically aggressive characteristics. The ovarian metastasis rate was high (16.3%, 7/43). The median maximum diameter of the tumour (MDOT) was 4.3 cm (range, 0.5-8.0 cm). MDOT was significantly associated with OS (P = 0.009), and the optimal cut-off value to define bulky MDA was 5.5 cm (P < 0.0001, χ= 21.161) using X-tile software. Independent prognostic factors included MDOT (HR = 10.095, P = 0.001) and ovarian metastasis (HR = 5.888, P = 0.008) for OS and MDOT (HR = 3.944, P = 0.028), ovarian metastasis (HR = 9.285, P = 0.001), and deep infiltration (HR = 3.627, P = 0.048) for PFS.

Conclusion: Endophytic lesion development and ovarian metastasis are likely in MDA. A bulky tumour and ovarian metastasis indicate a worse prognosis. Given the special biological features of MDA, it is more appropriate to use 5.5 cm as the threshold for defining a bulky tumour than it is to use 4 cm. Ovary removal should be given higher priority to improve prognosis.

Keywords: Minimal deviation adenocarcinoma; Ovarian metastasis; Prognosis; Tumour size; Uterine cervix.

Publication types

  • Observational Study

MeSH terms

  • Adenocarcinoma* / diagnosis
  • Adenocarcinoma* / surgery
  • Female
  • Humans
  • Longitudinal Studies
  • Neoplasm Staging
  • Ovarian Neoplasms* / diagnosis
  • Ovarian Neoplasms* / pathology
  • Ovarian Neoplasms* / surgery
  • Prognosis
  • Retrospective Studies
  • Uterine Cervical Neoplasms* / diagnosis
  • Uterine Cervical Neoplasms* / surgery