Exploring Uterine Involvement in Hysterectomy Samples Following Conization for Adenocarcinoma In Situ of the Uterine Cervix: Insights from a Multicenter Study by the FRANCOGYN Group.

Adenocarcinoma in situ cervical cancer fertility sparing surgery recurrence

Journal

Journal of gynecology obstetrics and human reproduction
ISSN: 2468-7847
Titre abrégé: J Gynecol Obstet Hum Reprod
Pays: France
ID NLM: 101701588

Informations de publication

Date de publication:
27 Jul 2024
Historique:
received: 27 05 2024
revised: 01 07 2024
accepted: 21 07 2024
medline: 30 7 2024
pubmed: 30 7 2024
entrez: 29 7 2024
Statut: aheadofprint

Résumé

Adenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy is standard, conservative management may be considered for women desiring future pregnancies. This study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional therapy with clear margins for AIS. A retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative predictors of residual disease and comparing recurrence rates between patients with and without residual disease. Of 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group, 18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI (27.5 kg/m² vs. 23.6 kg/m², p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences were observed during follow-up. Despite clear margins on the initial conization for AIS, 20% of patients had residual disease in their hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after completing childbearing, even if initial margins are clear.

Sections du résumé

BACKGROUND BACKGROUND
Adenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy is standard, conservative management may be considered for women desiring future pregnancies. This study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional therapy with clear margins for AIS.
METHODS METHODS
A retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative predictors of residual disease and comparing recurrence rates between patients with and without residual disease.
RESULTS RESULTS
Of 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group, 18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI (27.5 kg/m² vs. 23.6 kg/m², p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences were observed during follow-up.
CONCLUSION CONCLUSIONS
Despite clear margins on the initial conization for AIS, 20% of patients had residual disease in their hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after completing childbearing, even if initial margins are clear.

Identifiants

DOI: 10.1016/j.jogoh.2024.102826 PMID: 39074662
pubmed: 39074662
pii: S2468-7847(24)00105-3
doi: 10.1016/j.jogoh.2024.102826
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

102826

Informations de copyright

Copyright © 2024. Published by Elsevier Masson SAS.

Auteurs

LE Gac Marjolaine (LG)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France.

Benoit Louise (B)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France; INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris. Electronic address: louise.benoit@aphp.fr.

Koual Meriem (K)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France; INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris.

Bentivegna Enrica (B)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France.

Bolze Pierre-Adrien (B)

Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France.

Kerbage Yohan (K)

CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.

Raimond Emilie (R)

Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.

Lecointre Lise (L)

Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France.

Carcopino Xavier (C)

Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France.

Canlorbe Geoffroy (C)

Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique -Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France.

Philip Charles-André (P)

Department of Obstetrics and Gynecology, CHU Lyon Croix Rousse, Lyon, France.

Nguyen-Xuan Huyen-Thu (NX)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France.

Bats Anne-Sophie (B)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France; INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, Paris.

Azaïs Henri (A)

Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP.Centre, Paris, France; INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, Paris.

Classifications MeSH