Anna K Dietl1, Matthias W Beckmann2, Konrad Aumann3,4. 1. Department of Obstetrics and Gynecology, University of Erlangen, 91054, Erlangen, Germany. anna.dietl@uk-erlangen.de. 2. Department of Obstetrics and Gynecology, University of Erlangen, 91054, Erlangen, Germany. 3. Center for Pathology Allgaeu, Klinikverbund Allgaeu, Kempten, Germany. 4. Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
Abstract
PURPOSE: Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer. In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib1 VGA. METHODS: Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia-Ib1). RESULTS: A total of 271 patients were included in our literature review. 54 (20%) patients were treated by "conservative management" (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by "invasive management" (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA. CONCLUSION: The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.
PURPOSE: Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer. In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib1 VGA. METHODS: Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia-Ib1). RESULTS: A total of 271 patients were included in our literature review. 54 (20%) patients were treated by "conservative management" (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by "invasive management" (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA. CONCLUSION: The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.
Authors: Saskia Bulk; Otto Visser; Lawrence Rozendaal; René H M Verheijen; Chris J L M Meijer Journal: Int J Cancer Date: 2005-03-01 Impact factor: 7.396