The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (RFS) and patterns of failure, in patients with SCC and ADC of cervix treated with definitive radiotherapy and to determine whether ADC should be treated differently.
Total of 494 patients treated between January 1996 and December 2012 with definitive radiotherapy were included for analysis. Survival probabilities were estimated using Kaplan–Meier method, and differences between the groups were compared using long-rank test. Cox proportional hazards models were used to determine the role of histology after adjusting for potential confounders impacting on survival.
The 5-year RFS of node-negative SCC and ADC was 79% and 75% and of node-positive SCC and ADC was 51% and 37%, respectively. The 5-year OS was 74% for both node-negative SCC and ADC and 54% and 42% for node-positive SCC and ADC, respectively. This difference in RFS and OS among these four subgroups was not significant. The tumour volume (p = 0.005), corpus invasion (p = 0.022) and lymph node involvement (p < 0.001) were significant predictors of RFS, whereas histology (p = 0.204) was not. Increasing age (p < 0.001), ECOG performance score 2 (p = 0.04), tumour volume (p = 0.009) and lymph node involvement (p < 0.001) were predictive for OS, but histology (p = 0.458) was not. There was no difference in pelvic and extra-pelvic failure of the two histological subtypes.
Both these histological types exhibit similar clinical behaviour and survival when matched for prognostic factors. Hence, current standard of care was equally effective in both histological types.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Availability of Data and Material
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Wang SS, Sherman ME, Hildesheim A, Lacey JV, Devesa S. Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976–2000. Cancer. 2004;100(5):1035–44. https://doi.org/10.1002/cncr.20064.
Hopkins MP, Morley GW. A comparison of adenocarcinoma and squamous cell carcinoma of the cervix. Obstet Gynecol. 1991. https://doi.org/10.1016/0020-7292(92)90065-q.
Chen RJ, Lin YH, Chen CA, Huang SC, Chow SN, Hsieh CY. Influence of histologic type and age on survival rates for invasive cervical carcinoma in Taiwan. Gynecol Oncol. 1999;73(2):184–90. https://doi.org/10.1006/gyno.1999.5364.
Tinga DJ, Bouma J, Aalders JG. Patients with squamous cell versus adeno(Squamous) carcinoma of the cervix, what factors determine the prognosis? Int J Gynecol Cancer. 1992;2(2):83–91. https://doi.org/10.1046/j.1525-1438.1992.02020083.x.
Kleine W, Rau K, Schwoeorer D, Pfleiderer A. Prognosis of the adenocarcinoma of the cervix uteri: a comparative study. Gynecol Oncol. 1989;35(2):145–9. https://doi.org/10.1016/0090-8258(89)90032-2.
Galic V, Herzog TJ, Lewin SN, et al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol. 2012;125(2):287–91. https://doi.org/10.1016/j.ygyno.2012.01.012.
Endo D, Todo Y, Okamoto K, Minobe S, Kato H, Nishiyama N. Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a japanese cohort. J Gynecol Oncol. 2015;26(1):12–8. https://doi.org/10.3802/jgo.2015.26.1.12.
Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet. 2019;145(1):129–35. https://doi.org/10.1002/ijgo.12749.
Yan DD, Tang Q, Chen JH, Tu YQ, Lv XJ. Prognostic value of the 2018 FIGO staging system for cervical cancer patients with surgical risk factors. Cancer Manag Res. 2019;11:5473–80. https://doi.org/10.2147/CMAR.S203059.
Narayan K, Fisher RJ, Bernshaw D, Shakher R, Hicks RJ. Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by positron emission tomography and treated With curative intent. Int J Gynecol Cancer. 2009;19(5):912–8. https://doi.org/10.1111/IGC.0b013e3181a58d3f.
Lin MY, Kondalsamy-Chennakesavan S, Bernshaw D, Khaw P, Narayan K. Carcinoma of the cervix in elderly patients treated with radiotherapy: Patterns of care and treatment outcomes. J Gynecol Oncol. 2016;27(6):1–11. https://doi.org/10.3802/jgo.2016.27.e59.
Narayan K, van Dyk S, Bernshaw D, Khaw P, Mileshkin L, Kondalsamy-Chennakesavan S. Ultrasound guided conformal brachytherapy of cervix cancer: survival, patterns of failure, and late complications. J Gynecol Oncol. 2014;25(3):206–13. https://doi.org/10.3802/jgo.2014.25.3.206.
Rajasooriyar C, Van Dyk S, Bernshaw D, Kondalsamy-Chennakesavan S, Barkati M, Narayan K. Patterns of failure and treatment-related toxicity in advanced cervical cancer patients treated using extended field radiotherapy with curative intent. Int J Radiat Oncol Biol Phys. 2011;80(2):422–8. https://doi.org/10.1016/j.ijrobp.2010.02.026.
Williams NL, Werner TL, Jarboe EA, Gaffney DK. Adenocarcinoma of the cervix: Should we treat it differently? Curr Oncol Rep. 2015. https://doi.org/10.1007/s11912-015-0440-6.
Atahan IL, Onal C, Ozyar E, Yiliz F, Selek U, Kose F. Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study. Int J Gynecol Cancer. 2007;17(4):833–42. https://doi.org/10.1111/j.1525-1438.2007.00895.x.
Matsuo K, Machida H, Blake EA, Takiuchi T, Mikami M, Roman LD. Significance of uterine corpus tumor invasion in early-stage cervical cancer. Eur J Surg Oncol. 2017;43(4):725–34. https://doi.org/10.1016/j.ejso.2017.01.017.
Katanyoo K, Sanguanrungsirikul S, Manusirivithaya S. Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer. Gynecol Oncol. 2012;125(2):292–6. https://doi.org/10.1016/j.ygyno.2012.01.034.
Lai CH, Hsueh S, Hong JH, et al. Are adenocarcinomas and adenosquamous carcinomas different from squamous carcinomas in stage IB and II cervical cancer patients undergoing primary radical surgery? Int J Gynecol Cancer. 1999;9(1):28–36. https://doi.org/10.1046/j.1525-1438.1999.09895.x.
Waldenström AC, Horvath G. Survival of patients with adenocarcinoma of the uterine cervix in western Sweden. Int J Gynecol Cancer. 1999;9(1):18–23. https://doi.org/10.1046/j.1525-1438.1999.09873.x.
Rose PG, Java JJ, Whitney CW, Stehman FB, Lanciano R, Thomas GM. Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in Gynecologic Oncology Group trials of cisplatin-based chemoradiation. Gynecol Oncol. 2014;135(2):208–12. https://doi.org/10.1016/j.ygyno.2014.08.018.
Barillot I, Horiot JC, Pigneux J, et al. Carcinoma of the intact uterine cervix treated with radiotherapy alone: a French cooperative study: update and multivariate analysis of prognostics factors. Int J Radiat Oncol Biol Phys. 1997;38(5):969–78. https://doi.org/10.1016/S0360-3016(97)00145-4.
Narayan K, Fisher R, Bernshaw D. Significance of tumor volume and corpus uteri invasion in cervical cancer patients treated by radiotherapy. Int J Gynecol Cancer. 2006;16(2):623–30. https://doi.org/10.1111/j.1525-1438.2006.00379.x.
Quinn BA, Deng X, Colton A, Bandyopadhyay D, Carter JS, Fields EC. Increasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival. Brachytherapy. 2019. https://doi.org/10.1016/j.brachy.2018.08.016.
Rose PG, Java J, Whitney CW, et al. Nomograms predicting progression-free survival, overall survival, and pelvic recurrence in locally advanced cervical cancer developed from an analysis of identifiable prognostic factors in patients from NRG oncology/gynecologic oncology group randomized t. J Clin Oncol. 2015;33(19):2136–42. https://doi.org/10.1200/JCO.2014.57.7122.
Eifel PJ, Morris M, Oswald MJ, Taylor Wharton J, Delclos L. Adenocarcinoma of the uterine cervix prognosis and patterns of failure in 367 cases. Cancer. 1990;65(11):2507–14. https://doi.org/10.1002/1097-0142(19900601)65:11%3c2507::AID-CNCR2820651120%3e3.0.CO;2-9.
NCT01414608. Cisplatin and Radiation Therapy With or Without Carboplatin and Paclitaxel in Patients With Locally Advanced Cervical Cancer. https://clinicaltrials.gov/show/nct01414608. 2011.
Green JA, Kirwan JM, Tierney JF, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001;358(9284):781–6. https://doi.org/10.1016/S0140-6736(01)05965-7.
No funding was obtained for this study.
Conflict of interest
No absolute or potential conflict of interest exists.
Ethical clearance was obtained from the ‘Ethics review committee’, “Institutional Review Board” of the Peter MacCallum Cancer Centre, Melbourne, Australia, Faculty of Medicine, University of Jaffna, Sri Lanka; approval number: 16/86R J/ERC/14/51/NDR/00800.
Consent for Publication
All authors agree to publish this paper on the Indian Journal of Gynaecologic cancers.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lin, M.Y., Rajasooriyar, C., Kondalsamy-Chennakesavan, S. et al. Should Adenocarcinoma of Cervix be Treated Differently to Squamous Cell Carcinoma?. Indian J Gynecol Oncolog 19, 22 (2021). https://doi.org/10.1007/s40944-021-00503-1
- Cervix cancer
- Squamous carcinoma