Adenosquamous histology predicts a poor outcome for patients with advanced‐stage, but not early‐stage, cervical carcinoma

Abstract

BACKGROUND The objective of this study was to compare survival between patients with adenocarcinoma and patients with adenosquamous carcinoma of the cervix. METHODS Patients who were diagnosed with invasive cervical carcinoma from 1988 to 1999 were identified from the Automated Central Tumor Registry for the United States Military Health Care System. Clinical data, including race, age at diagnosis, histology, tumor grade, disease stage, lymph node status, treatment modality, and survival, were collected. Survival analysis was performed with Kaplan–Meier survival curves and compared using the log‐rank test. RESULTS A total of 273 women were identified, 185 women with a histologic diagnosis of adenocarcinoma (AC) and 88 women with a diagnosis of adenosquamous carcinoma (ASC). Among the women with ASC, only 5% had Grade 1 tumors, and 66% had Grade 3 tumors. By comparison, among the women with AC, 37% had Grade 1 tumors, and 26% had Grade 3 tumors (P < 0.001). There was no difference in the incidence of positive lymph nodes or in the number of patients who underwent radical hysterectomy as primary treatment between patients with ASC and patients with AC. More patients with ASC received radiation therapy (51% vs. 28%) or chemotherapy (29% vs. 12%) as treatment (P < 0.001). Patients who had tumors with ASC histology had a significantly decreased 5‐year survival rate compared with patients who had tumors with AC histology (65% vs. 83%; P < 0.002). When patients with early‐stage cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] Stage I) were examined separately, there was no statistically significant difference in the 5‐year survival rate (AC, 89%; ASC, 86%; P = 0.644). However, when patients with advanced‐stage disease (FIGO Stages II–IV) were analyzed, ASC was associated with a significant decrease in median and overall survival (P = 0.01). When the results were analyzed by grade, patients who had tumors with ASC histology had a shorter survival compared with patients who had AC histology of any grade; however, this was a significant difference only for patients with Grade 1 tumors: The 5‐year survival rate for patients with Grade 1 AC was 93%, compared with 50% for patients with Grade 1 ASC (P < 0.01). CONCLUSIONS ASC histology appears to be an independent predictor of poor outcome in women with cervical carcinoma compared with their counterparts who have pure AC. The significant decrease in survival was observed only in patients with advanced‐stage cervical carcinoma. This decreased survival may be related mainly to the grade of ASC. Cancer 2003;97:2196–202. Published 2003 American Cancer Society. DOI 10.1002/cncr.11371

Clinical and Pathological Factors Related to the Prognosis of Chinese Patients with Stage Ⅰb To Ⅱb Cervical Cancer

“…Park et al found that the DFS and OS of patients with adenocarcinoma were significantly shorter than that of patients with squamous cell carcinoma (Park et al, 2010). Farley et al reported that the 5-year survival of patients with stage II -IV adenosquamous carcinoma was significantly lower than that of patients with adenocarcinoma of the same stage (Farley et al, 2003). Chen et al reported that the 5-year survival of patients with small cell carcinoma was significantly lower than that of patients with squamous cell carcinoma or adenocarcinoma (Chen et al, 2008).…”

“…Following surgery, adenocarcinoma, adenosquamous carcinoma and small cell carcinoma need multimodality treatment with radiotherapy and chemotherapy (Farley et al, 2003;Chen et al, 2008;Park et al, 2010). It is believed that patients with stage Ⅰb-IIb non-squamous cell cervical cancer should be given comprehensive postoperative adjuvant therapy including radiotherapy and chemotherapy.…”

The role of human papillomavirus type 16 and the fragile histidine triad gene in the outcome of cervical neoplastic lesions

“…Although HR HPV is known to be pivotal in the development of cervical cancer, its role in cancer progression as assessed here for HPV16 against histological markers was found to be limited to an association with vascular involvement. HPV16 occurred more frequently in moderately differentiated cancers and did not show any preference for adenosquamous carcinoma, a histological type which is usually poorly differentiated and has a lower 5-year survival rate (Davy et al, 2003;Farley et al, 2003). In contrast, LOH in 3p was found to be associated with poor differentiation, increased depth of invasion and, when the LOH occurred in FHIT intron 3 with lymph node involvement or in FHIT intron 5 with abnormal FHIT protein expression (Table 3b).…”

Prognostic Impact of Histology in Patients with Cervical Squamous Cell Carcinoma, Adenocarcinoma and Small Cell Neuroendocrine Carcinoma

“…The most common type of cervical cancer is squamous cell carcinoma (SCC) which comprises approximately 75% of all cervical cancers (Kosary, 1994;Farley et al, 2003).The second most common type is adenocarcinoma (ADC) accounting for about 20% (Wang et al, 2004). The remaining cases consist of rare histological types including small cell neuroendocrine carcinoma (SNEC) (Kosary, 1994;Farley et al, 2003).…”

“…The remaining cases consist of rare histological types including small cell neuroendocrine carcinoma (SNEC) (Kosary, 1994;Farley et al, 2003). Over time, the rates of invasive SCC have declined, while the incidence of 5356 ADC (Smith et al, 2000;Wang et al, 2004;Mathew and George, 2009) and SNEC (Vinh-Hung et al, 2007) have increased.…”