[1039] Prognostic Factors of Adenocarcinoma of the Endocervix: Pattern of Invasion vs Depth of Invasion

I Aguilera-Barrantes, EG Silva. M.D.Anderson Cancer Center, Houston, TX

Background: The treatment of endocervical adenocarcinoma (EA) depends primarily on the depth of invasion. The grade of the tumor is typically considered a less important prognostic factor and the pattern of invasion has not been evaluated. The purpose of our study is to evaluate whether these features impact prognosis.
Design: We reviewed 43 cases of invasive adenocarcinoma of the endocervix seen at our institution. For each case 1 to 49 slides (median 9) of cone/ LEEP and/or hysterectomy specimens were available for review. Follow up (FU) was obtained in all cases. These cases were divided in two groups. One group with pushing border (PB) of invasion or PB with focal infiltration (defined as 1 or 2 foci of infiltration) and the other group with diffuse infiltration (DI) of the stroma. Tumors were graded observing only architectural features and were classified as well differentiated (WD) if composed only of glands, moderated differentiated (MD) composed of glands and solid tumor and poorly differentiated (PD) predominantly solid.
Results: Patient ages ranged 25 to 58 (mean 39). The follow up for those who survived ranged from 37 to 250 months (median 94 months). A summary of the results for all patients is in table 1.

Table 1

Pattern of invasion	n	Depth mm	Grade	LVI	LN Mets	FU	TX
PB	22	1 to 14 (median 5.5)	21/22 WD; 1/21 MD	1/22	0/15	22/22 NED	5/22
DI	21	2 to 14 (median 5)	10/21 WD; 8/21 MD; 3/21 PD	13/21	6/18	8/21 DOD; 2/21 AWD; 11/21 NED	11/21
P value			0.0006 (WD)	<0.0001	0.0213	0.0002 (NED)

LVI: Lymphovascular invasion; LN Mets: lymph node metastasis (on cases with lymph node dissection); Depth: Depth of invasion; TX: Adjuvant treatment after surgery; NED: no evidence of disease; AWD: Alive with disease; DOD: died of disease; P value: calculated with Fisher's exact test

Within the group with pushing margin there is a subgroup (4 cases) with "canalicular" pattern that appears to have excellent prognosis (NED with a FU 86 to 232m) in spite of deep invasion (5 to 14mm invasion).
Conclusions: The pattern of invasion should be considered a very important prognostic indicator in adenocarcinoma of the cervix. In this study it was a better prognostic indicator than depth of invasion. Tumor grade also correlates well with prognosis. LVI is more frequently seen in cases with DI. The significance of classical histological parameters should be re-evaluated in the decision making regarding the treatment of these frequently young patients.
Category: Gynecologic & Obstetrics

Tuesday, March 23, 2010 9:30 AM

Poster Session III # 182, Tuesday Morning