Should Adenocarcinoma of Cervix be Treated Differently to Squamous Cell Carcinoma?

Abstract

Aim

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.

Methods

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.

Results

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.

Conclusion

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.

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Availability of Data and Material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. 1.

    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.

    Article  PubMed  Google Scholar 

  2. 2.

    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.

    Article  PubMed  Google Scholar 

  3. 3.

    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.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    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.

    Article  PubMed  Google Scholar 

  5. 5.

    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.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    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.

    Article  PubMed  Google Scholar 

  7. 7.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    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.

    Article  Google Scholar 

  9. 9.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    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.

    Article  PubMed  Google Scholar 

  11. 11.

    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.

    Article  Google Scholar 

  12. 12.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    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.

    Article  PubMed  Google Scholar 

  14. 14.

    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.

    Article  PubMed  Google Scholar 

  15. 15.

    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.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    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.

    Article  PubMed  Google Scholar 

  18. 18.

    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.

    Article  PubMed  Google Scholar 

  19. 19.

    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.

    Article  PubMed  Google Scholar 

  20. 20.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    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.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    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.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    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.

    Article  PubMed  Google Scholar 

  24. 24.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    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.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    NCT01414608. Cisplatin and Radiation Therapy With or Without Carboplatin and Paclitaxel in Patients With Locally Advanced Cervical Cancer. https://clinicaltrials.gov/show/nct01414608. 2011.

  27. 27.

    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.

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Chrishanthi Rajasooriyar or Kailash Narayan.

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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.

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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

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Keywords

  • Cervix cancer
  • Squamous carcinoma
  • Adenocarcinoma