Outcomes of Patients Undergoing Radical Hysterectomy for Cervical Cancer of High-Risk Histological Subtypes

Abstract

Structured Abstract Introduction The most common types of cervical cancer are squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma, referred to here collectively as SA cervical cancer. Other types of cervical cancer, referred to here collectively as nonsquamous/nonadenocarcinoma (NSNA) cervical cancer, include neuroendocrine, small cell, clear cell, sarcomatoid, and serous tumors. Anecdotally, NSNA tumors seem to have a worse prognosis than their SA counterparts. We sought to determine whether patients with early-stage NSNA have a worse prognosis than those with early-stage SA cervical cancer. Methods We retrospectively reviewed charts of women with stage IA1-IB2 NSNA cervical cancer treated by radical hysterectomy and lymph node staging at MD Anderson Cancer Center from 1990 to 2006. NSNA patients were matched 1:2 to patients with grade 3 SA lesions on the basis of stage, age at diagnosis, tumor size, and date of diagnosis. Results Eighteen patients with NSNA primary cervical cancer subtypes [neuroendocrine (n=7), small cell (5), clear cell (4), papillary serous (1), and sarcomatoid (1)] were matched to 36 patients with grade 3 SA lesions. There were no differences between the 2 groups in age, body mass index, clinical stage, or lesion size. The 2 groups also did not differ with respect to number of nodes resected, lymphovascular space invasion, margin status, lymph node metastasis, or adjuvant radiation therapy or chemotherapy. At a median follow-up of 44 months, median progression-free and overall survivals had not been reached; however, both progression-free survival (p=0.018) and overall survival (p=0.028) were worse for the NSNA group. The 5-year progression-free and overall survival rates were 61.2% and 67.6%, respectively, for the NSNA group, compared to 90.1% and 88.3%, respectively, for the SA group. Conclusions Patients with early-stage NSNA cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy have a worse prognosis than patients with grade 3 SA lesions. Patients with NSNA tumors may require a multimodality approach to their cancer care.

Is It Possible to Perform Less Radical Surgery for Invasive Uterine Cervical Cancer?

“…The histologic subtype of this patient was small cell carcinoma. In fact, high-risk histologies, such as neuroendocrine and serous tumors of the cervix, have poor prognosis than squamous cell carcinoma and adenocarcinoma [17]. Meanwhile, Lee et al [18] reported that there was no significant difference in survival outcomes between adenocarcinoma and adenosquamous carcinoma in early-stage cervical cancer patient after radical hysterectomy.…”

The potential for less radical surgery in women with stage IA2–IB1 cervical cancer

“…In addition, rare histologies-e.g. neuroendocrine carcinoma and glassy cell carcinoma-were not excluded, despite potentially having different biological behaviors from those of squamous cell carcinoma (SCC), adenocarcinoma, or adenosquamous carcinoma [15,16]. Finally, most of the studies were limited to small samples and single institutions.…”

Serous Carcinoma of the Uterine Cervix, an Extremely Rare Aggressive Entity: A Literature Review

“…According to ESMO, tumour risk assessment includes nodal status, lymphovascular space invasion, tumour size and histological type. Among the factors mentioned in the literature that have shown prognostic value in cervical cancer are also tumour differentiation, Ki67, expression of p53 and serum Ca 125 level [2, 12, 25-27]. Poor prognosis is associated with tumour invasion >10 mm, tumour size >2 cm, age <65 years, FIGO stage >I, elevated serum level of Ca 125 and the presence of lymph node metastases [9, 28, 29].…”

“…More precisely, this group of patients belongs to the nonsquamous/non-adenocarcinoma category, along with neuroendocrine, small cell, clear cell and sarcomatoid tumours, present in less than 5% of all malignancies of the uterine cervix [2]. According to the data in the literature, although the incidence of cervical cancer has declined over time, the incidence of nonsquamous/non-adenocarcinoma and adenocarcinoma histologic subtypes has increased, especially in young women [2, 3]. USCC is a sporadic pathological form accounting for only less than 1% of all cervical cancer cases [4-7].…”