Comparison of Outcomes and Prognostic Factors Between Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma Patients After Radical Surgery and Postoperative Adjuvant Radiotherapy

Abstract

Purpose

No consensus has been reached regarding the survival difference between cervical adenocarcinoma (ADC) and adenosquamous carcinoma (ASC) patients. The purpose of this study was to compare survival outcomes and prognostic factors between early-stage ADC and ASC patients.

Patients and Methods

We retrospectively reviewed stage IB-IIA patients with ADC and ASC who underwent radical hysterectomy and postoperative radiotherapy between June 2012 and December 2017.

Results

A total of 125 patients were enrolled in our study (97 with ADC and 28 with ASC). The median follow-up period was 53.4 months. Compared with ASC patients, patients with ADC tended to have a higher proportion of positive pelvic lymph nodes (7.1% and 26.8%, respectively; p = 0.028). The most common site of distant metastasis was the lung, followed by the intestine and colon. The 5-year overall survival (OS), disease-free survival (DFS), pelvic control, and distant control rates for ADC and ASC patients were 83.6% and 92.0% (p = 0.349), 77.5% and 87.7% (p = 0.279), 81.8% and 96.2% (p = 0.121), and 88.3% and 87.7% (p = 0.948), respectively. Parametrial invasion was a prognostic factor for OS. Lymphovascular space involvement was a prognostic factor for DFS.

Conclusion

ADC patients were more likely to have positive pelvic lymph nodes than those with ASC. There was no significant difference in survival outcomes between patients with ADC and ASC.

Keywords:

• cervical adenocarcinoma
• adenosquamous carcinoma
• survival outcomes
• parametrial invasion
• lymphovascular space involvement

Abbreviations

SCC, squamous cell carcinoma; ADC, adenocarcinoma; ASC, adenosquamous carcinoma; FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival; DFS, disease-free survival; RT, radiotherapy; CCRT, concurrent radiochemotherapy; PLN, pelvic lymph node; LVSI, lymphovascular space involvement; DSI, depth of stromal invasion; CTV, clinical target volume; CT, computed tomography; PCTV, planning clinical target volume; TCT, thinprep cytology test; MRI, magnetic resonance imaging; PET, positron emission tomography; CTCAE, Common Toxicity Criteria for Adverse Events; HR, hazard ratio; CI, confidence interval.

Ethics Approval

This protocol was approved by the Institutional Review Board of Peking Union Medical College Hospital. The ethical committee process number is S-K1710. This is a retrospective study and informed consent was unnecessary. The data was anonymized and maintained with confidentiality in this study. This manuscript does not cover any information about patients’ privacy. All procedures in this study were conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.