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Are adenocarcinomas and adenosquamous carcinomas different from squamous carcinomas in stage IB and II cervical
C.-H. Lai1, S. Hsueh, J.-H. Hong
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Abstract:
The aim of this study was to define clinicopathologic features and to investigate prognostic factors in early-stage cervical adenocarcinomas and adenosquamous carcinomas in patients undergoing primary radical surgery. One hundred thirty-four patients with stage IB or II cervical adenocarcinoma or adenosquamous carcinomas treated at a single institution were reviewed and compared to squamous carcinomas (N = 757) treated in the same period. Among adeno-adenosquamous carcinomas, stage II disease, parametrial extension, and deep cervical stromal invasion (>2/3) were associated with increased risk of pelvic lymph node metastases, while only clinical stage II, DNA index >1.3 (by flow cytometry), and pelvic node metastases were significantly associated with decreased survival by multivariate analyses. The five-year recurrence-free and overall survival rates of patients with adeno-adenosquamous vs squamous carcinoma were 72.2% vs 81.2% (P = 0.0109), and 74.1% vs 82.8% (P = 0.0136), respectively by Mantel-Cox test. After controlling confounding factors, histologic type (adeno-adenosquamous vs squamous) was confirmed as an independent prognostic factor for recurrence-free survival [relative risk (RR): 1.2792; 95% confidence interval (CI): 1.0628-1.5399, P = 0.0092) and overall survival (RR: 1.2594, 95% CI: 1.0467-1.5155, P = 0.0146) in the whole series (N = 891). Although pattern of relapse by histologic type was not significantly different, patients with recurrent adeno-adenosquamous carcinoma did significantly worse than those with recurrent squamous carcinoma. In conclusion, the prognosis of adeno-adenosquamous carcinoma of the cervix is slightly worse than squamous tumors. Since salvage of recurrent adeno-adenosquamous carcinoma after primary radical surgery is generally ineffective using conventional treatment, innovative strategies are necessary for the high-risk group after primary surgery and all recurrent adeno-adenosquamous carcinomas regardless of size or site.