Clinical Retrospective Evaluation Of 52 Patients With Occult Invasive Cervical Cancers

Objective:Occult invasive cervical cancers are detected after simple hysterectomy carried out for supposedly benign gynecologic conditions.In this study,we respectively evaluated reasons of missed diagnosis of cervical cancer and factors affecting the prognosis of OICC patients.Methods:Retrospectively analyzed the clinical characteristics and prognosis of 52 patients with an invasive cancer detected after a simple hysterectomy in Qilu Hospital of Shandong University from Jan.2006 to Dec.2017.Frequency distributions were compared using the chi-square and Fisher's exact tests.Survival curves and rates were calculated using the Kaplan-Meier method.Differences in survival were assessed using the log-rank test for categorical factors.A P value of<0.05 indicated a significant difference.Data were analyzed using SPSS software for Windows.Results:1.Of the 2394 patients with invasive cervical cancer who were treated and followed at the hospital during the study period,52(2.17%)had occult invasive cervical cancer found after simple hysterectomy carried out for benign gynecologic conditions.2.The age of 52 patients was from 32 to 81 years.The mean age was 52.92±11.36 years,and the median age was 52 years.38 patients(73.1%)were?45 years old.Nineteen patients(36.5%)had no clinical symptom.The preoperative examination of 24 patients(46.1%)showed no clinical sign.Forty-five patients underwent transvaginal color Doppler ultrasonography and 30 cases(66.7%)were normal.The indications for simple hysterectomy included HSIL(69.2%),pelvic mass(7.7%),endometrial lesions(5.8%),leiomyoma(3.8%),adenomyosis(3.8%),cervical lesions(3.8%),uterine empyema(1.9%),dysfunctional uterine bleeding(1.9%)and abdominal pain(1.9%).3.Nineteen cases(36.5%)did not have screening of high-risk human papillomavirus test and cytology together.Thirty-four patients(65.4%)who underwent high-risk HPV,an abnormal cytology(?ASCUS or AGC)was identified in 30 patients,4 cases were negative,and the false negative rate was 11.8%(4/52).Of the 39 patients(75%)who underwent TCT,30 cases(76.9%)were positive,9 cases were negative,and the false negative rate was 23.1%(9/39).There were 40 cases underwent a colposcopy-directed biopsy,and CIN?/? was diagnosed in 39 cases(97.5%)using this procedure.Of the 39 patients who underwent inadvertent simple hysterectomy for CIN?/?,35(89.7%)patients were so due to the failure of conization.4.Among the 52 cases,20 cases(38.5%)did not require further treatment and 32 cases(61.5%)had to receive further treatment after simple hysterectomy.Of the 32 patients,six patients refused fturther treatment and only 26 cases(50%)received further treatment,including secondary surgery in 11 patients(21.2%)and adjuvant therapy in 15 patients(28.8%).There was no significant difference in complications,5-year DFS and 5-year OS between secondary surgery and adjuvant therapy.5.The most common histology of the tumors(75%)was squamous cell carcinoma.Thirteen(25%)patients had positive LVSI.Fifteen(28.8%)patients had deep stromal invasion(DSI).Three patients(5.8%)had involvement of the parametrium.Pelvic lymphadenectomy was performed in 13 cases(25%),including secondary surgery in 11 patients,two patients who had lymph nodes dissection after diagnosed with malignant tumor by frozen section.Among them,2 patients were positive of lymph nodes(15.4%).6.After a median follow-up time of 28.5 months(range 12-144 months),eight of these patients had recurrent disease and the total recurrence rate was 16.7%.The median time to recurrence was 12 months(range 6-69 months).Tumor size(P=0.025),and DSI(P=0.005)played an important role on recurrence.Meanwhile,age,histology,LVSI,parametrial involvement,lymph node metastasis and complementary treatment approach w-ere not significant statistically.There were seven deaths,six(85.7%)died of disease.The 5-year DFS rates was 71%.Log-rank test results showed that tumor size(P=0.002),DSI(P<0.001)and parametrial involvement(P=0.01)were related to the DFS.While age,histology,LVSI,lymph node metastasis and complementary treatment approach were not statistically significant with DFS of OICC patients.The 5-year OS of patients was 85%.Recurrence(P<0.001),tumor size(P<0.001),DSI(P=0.001),parametrial involvement(P=0.005)were related to the OS.Other factors,such as age,histology,LVSI,Lymph node metastasis,complementary treatment approach and so on,were not statistically significant with OS of OICC patients.Conclusion:1.Cervical screening should be routinely performed before simple hysterectomy to avoid missed diagnosis of cervical cancer.2.For CIN patients,a colposcopy-directed biopsy cannot completely replace conization.Conization should be performed routinely before simple hysterectomy.3.Tumor size>2cm,DSI and parametrial involvement were related to the DFS and OS.