Adenosquamous Carcinoma of the Uterine Cervix – Impact of Histology on Clinical Management

Abstract

Introduction

Historically, the incidence rate of cervical cancer (CC) in Eastern Europe and particularly in Bulgaria has constantly been higher than that in the other European countries. Adenosquamous carcinoma (ASC) is a rare histological subtype of CC with incidence rate of less than 6 per 100,000. We aimed to analyze the epidemiology and prognosis of all Bulgarian patients with ASC, registered at the Bulgarian National Cancer Registry (BNCR), and to compare patients’ characteristics and outcomes with those of patients, treated at a large specialized institution – the Department of Gynecologic Oncology, University Hospital in Pleven, Bulgaria.

Materials and Methods

This is a retrospective study of all cases of ASC, registered at the BNCR for a 10-year period of time. The Kaplan–Meier analysis with Log rank test was used to estimate the significant differences.

Results

The incidence rate of ASC was calculated as 3.2% of all CC registered in BNCR and 4.97% of all stage I patients, treated in our department. The 5-year overall survival (OS) rate of all patients with ASC tumors from the registry was 50.5%. A total of 171 (48.4%) of the patients had T1 tumors and a 5-year OS of 67.1%. Lymph node status was a significant prognostic factor for OS (p=0.001). Thirty-one patients with T1 tumors and ASC histology were treated in our department for the same period of time. Lymph node metastases were found in 10 of them (32.2%). The 5-year observed OS in ASC group was 74.19%.

Conclusion

The histological subtype of cancer of the uterine cervix has an impact on prognosis and should not be simply considered as a descriptive characteristic but a poor prognostic feature and should be an integral part of the decision-making in clinical management of patients.

Keywords:

• adenosquamous cervical carcinoma
• incidence rate
• clinical features
• survival rate
• prognosis

Acknowledgments

This publication emerged from the European Cooperation in Science & Technology program (EU COST)–COST Action CA18117:GYNOCARE: “European network for Gynecological Rare Cancer research: From Concept to Cure”. A.Y., M.V.-S., R.D.F., J.C.-A. and XXXX are authors. All authors are Action management committee members and/or form part of Working Group 1, and J.C.-A. is the Chairperson of this Action. Minka Yordanova, Expert System Software and Database, Bulgarian National Cancer Registry. Nikolai Genov – Leap Dynamics.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work Funding: The publication of this manuscript was funded by the European Cooperation in Science & Technology program (EU COST)–COST Action CA18117: GYNOCARE- “European network for Gynaecological Rare Cancer research: From Concept to Cure”.

Disclosure

The authors declare no competing interests in this work.