Incidence and Outcomes of Occult Uterine Cancer in Uteri Removed for Prolapse

Abstract

Introduction and Hypothesis: To identify the incidence of occult endometrial cancer diagnosed following hysterectomy for the repair of pelvic organ prolapse, and compare patient outcomes to a control cohort of preoperatively diagnosed endometrial cancer patients. Methods: A retrospective cohort study of patients ≥50 years with endometrial cancer between 2010 and 2020 was performed. Demographic, clinical, surgical, and oncologic variables were compared between occult endometrial cancer and preoperatively diagnosed endometrial cancer cohorts. Results: One thousand seventy-two patients were included, of which 30 (2.8%) had occult endometrial cancer diagnosed after prolapse surgery and 1042 (97.2%) were in the preoperatively diagnosed historic cohort. The incidence of occult endometrial cancer was 0.56% for all hysterectomies performed for pelvic organ prolapse. Patients in the occult endometrial cancer cohort were more likely to have grade I disease (85.2% vs. 52.1%, p < 0.001), less likely to have lymphovascular space invasion (10.7% vs. 31.8%) or >50% myometrial invasion (11.1% vs. 24.0%, p = 0.004) compared to the preoperatively diagnosed patients. Ten occult endometrial cancer patients (33.3%) underwent a second staging procedure; 83.3% (n = 25) of patients received care in compliance with comprehensive national cancer guidelines. Five-year recurrence free survival was 95.0% (95% CI 85.4–100%) and 66.8% (95% CI 59.3–74.4%) for preoperatively diagnosed cohort and occult endometrial cancer cohort, respectively, while 5-year overall survival was 90.9% (95% CI 78.9–100%) and 83.0% (95% CI 75.5–90.5%), respectively. Conclusions: The rate of incidental endometrial cancer after hysterectomy for pelvic organ prolapse was 0.56% in our cohort. Most occult diagnosed patients are diagnosed with early-stage and low-grade disease. The majority received care concurrent with National Comprehensive Cancer Network recommendations.