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

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.

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.

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.

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.