A total of 222 patients met the inclusion criteria and were analyzed. The mean patient age was 54.5 years (SD 11.7). The median body mass index was 31 (IQR 27.1-35.9) kg/m2. Postoperative stages were I in 162 (73%) patients, II in 25 (11.2%), III in 30 (13.5%), and IV in 5 (2.2%). Eighty-seven (39.2%) patients underwent lymphadenectomy.
All patients had an IOA. Frozen section biopsy was positive in 80 (36%) patients. The IOA was positive for ovarian involvement in 2 (0.9%) patients, uterine serosa involvement in 12 (5.4%), and cervical involvement in 29 (13%). Myometrial invasion was superficial in 34 (15.3%) patients, less than 50% deep in 137 (61.7%), and greater than 50% deep in 51 (23%). The presurgical tumor grade was grade 1 in 7 (11.1%) patients, grade 2 (73%) in 46 patients and grade 3 in 9 (14.3%) patients. In the final pathology report, the median tumor size was 40 mm (IQR 30-35), there was ovarian involvement in 10 (4.5%) patients, uterine serosa involvement in 3 (1.4%), and cervical involvement in 55 (24.8%). Myometrial invasion was superficial in 34 (15.3%) patients, less than 50% gross depth invasion in 133 (59.5%), and greater than 50% gross depth invasion in 55 (24.8%). There was lymph node metastasis in 23 (10.4%) patients (Table 1).
The IOA showed an accuracy of 76.1% when compared with the postoperative assessment. It had an AUC of 0.74 (95% confidence interval [CI] 0.68-0.8), a sensitivity of 65.5%, a specificity of 83%, a positive predictive value of 71.3%, and a negative predictive value of 78.9%. Myometrial invasion had an AUC of 0.76 (95% CI 0.69-0.83) and an accuracy of 82.4% when compared with myometrial invasion in the final pathology report. Cervical involvement had an AUC of 0.61 (95% CI 0.55-0.68) and an accuracy of 77.5%. Uterine serosa involvement had an AUC of 0.47 (95% CI 0.46-0.49) and an accuracy of 93.2%. Ovarian involvement had an AUC of 0.55 (95% CI 0.45-0.65) and an accuracy of 95.5%. The rate of lymph node metastasis according to each parameter’s positivity was 25.5% for myometrium, 13.8% for cervix, 33.3% for uterine serosa, and 50% for ovary. (Table 2).
A total of 80 (36%) patients had positive IOA, and 142 (64%) were negative. Lymphadenectomy was performed on 69 (86.3%) patients in the positive IOA group and 18 (12.7%) in the negative IOA group (p<0.001). There was lymph node metastasis in 16 (20%) patients in the positive IOA group and 7 (4.9%) patients in the negative IOA group (p<0.001). Regarding intraoperative complications, patients in the positive IOA group had more intraoperative bleeding (375 ml, IQR 80-300) than those in the negative IOA group (150 ml, IQR 200-550) (p<0.001). Likewise, there were 8 (10%) blood transfusions in the positive frozen section biopsy group and none (0%) in the negative frozen section biopsy group (p<0.001). There were no differences found regarding age, menarche, menopause, weight, reintervention, stage IV disease, or ICU admission (Table 3).
The median follow-up duration was 43.8 (IQR 24.47-65.8) months. The 5-year overall survival rate for all patients was 95.3% (95% CI 89.5-97.9). Patients with a positive IOA had a 5-year overall survival rate of 92% (95% CI 79.05-97.1), whereas patients with a negative IOA had a 5-year overall survival rate of 97.7% (95% CI 93.08-99.26) (p=0.257). Patients who underwent lymphadenectomy had a 5-year overall survival rate of 94.7% (95% CI 83.4-98.4), whereas those who did not undergo lymphadenectomy had a 5-year overall survival rate of 96.2% (95% CI 89.8-98.6) (p=0.99). Patients with lymph node metastasis had a 5-year overall survival rate of 80.9% (95% CI 65.3-96.5), whereas patients without lymph node metastasis had a 5-year overall survival rate of 97.9% (95% CI 86.4-99.7) (p=0.04). (Figure 1)
The 5-year disease-free survival rate was 91.3% for all patients. Patients with a positive IOA had a 5-year disease-free survival rate of 86% (95% CI 73.5-92.91), whereas patients with a negative IOA had a 5-year disease-free survival rate of 94.4% (95% CI 87.29-97.62) (p=0.177). Patients who underwent lymphadenectomy had a 5-year disease-free survival rate of 91.1% (95% CI 80.94-96), whereas patients who did not undergo lymphadenectomy had a 5-year disease-free survival rate of 91.3% (95% CI 82.4-95.9) (p=0.789). Patients with lymph node disease had a 5-year disease-free survival rate of 91.3% (95% CI 82.4-95.8), whereas patients without lymph node disease had a 5-year disease-free survival rate of 93.9% (95% CI 81.6-98). (Figure 2)