Risk factors for poor prognosis in microinvasive adenocarcinoma of the uterine cervix (IA1 and IA2): A pooled analysis

Objective: To identify adverse risk factors for FIGO IA1 and IA2 cervical adenocarcinoma. Methods: PubMed was used to identify all microinvasive adenocarcinoma cases. Case specific data pooled for 35 "high risk" microinvasive adenocarcinoma (MIAC), defined as cases with lymph node or lymphovascular space involvement, positive surgical margins, or recurrence was compared with 478 "low risk" cases abstracted from the SEER database (1988-1997). Statistical methods included non-paired t and Fisher's Exact tests. Results: Survival for 1A1 and 1A2 MIAC is 99% and 98%, respectively. Significantly more 1A2 patients underwent aggressive radical surgery and received postoperative treatment. Parametrial involvement was rare (1/373 cases). Significantly more "high-risk" cases were of endometrioid histology (6/34 vs. 14/478, p = 0.001), whereas adenocarcinoma (p = 0.046) and mucinous (p = 0.021) tumors were observed in the "low-risk" group. Among the "high-risk" cases with at least 5 years follow-up, 1.4% has recurred or died. Conclusions: Endometrioid histology may be associated with late recurrence and worse survival in stage 1A1 and 1A2 MIAC.