Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy
Journal
Acta Obstetricia et Gynecologica Scandinavica
Journal Volume
93
Journal Issue
7
Pages
661-668
Date Issued
2014
Abstract
OBJECTIVE: To compare tumor characteristics and clinical outcome of patients with cervical locally advanced adenocarcinoma (AC)/adenosquamous carcinoma (ASC) and squamous cell carcinoma (SCC). DESIGN: Retrospective study. SETTING: National Taiwan University Hospital, Taipei, Taiwan. POPULATION: All patients with cervical SCC (n = 35), AC or ASC (n = 194) with FIGO stage ≥IIB who received definitive radiotherapy or concurrent chemoradiotherapy (CCRT) from January 1995 to December 2009. METHOD: Medical and histopathological record review. MAIN OUTCOME MEASURES: Progression-free survival (PFS), local recurrence-free survival, distant metastasis-free survival, and overall survival (OS). RESULTS: Compared with the SCC subgroup, patients with AC/ASC were significantly younger (p = 0.007), more of them without clinical symptoms were diagnosed by abnormal Pap smear findings (p = 0.043), and less responded to treatment (p = 0.018). After a median follow-up of 59.3 months, patients with AC/ASC had worse 5-year PFS (30.0% vs. 47.6%, p = 0.044), worse 5-year distant metastasis-free survival (41.5% vs. 69.9%, p = 0.005), and trends toward worse 5-year local recurrence-free survival (64.4% vs. 76.2%, p = 0.165) and worse 5-year OS (41.3% vs. 58.1%, p = 0.090) than patients with SCC. In univariate analysis, early FIGO stage and complete treatment response were significantly associated with PFS and OS. Histology of non-AC/ASC and Point A biologically equivalent doses in 2-Gy fractions >85 Gy were significantly associated with better PFS, and CCRT was significantly associated with better OS. In multivariate analysis, complete treatment response and early FIGO stage remained significant factors for predicting better PFS and OS. CONCLUSIONS: Cervical AC/ASC may be more aggressive than is SCC. For cervical AC/ASC, more comprehensively effective treatments are warranted.
SDGs
Other Subjects
adenosquamous carcinoma; adult; advanced cancer; aged; article; cancer patient; cancer prognosis; cancer radiotherapy; cancer recurrence; cancer survival; chemoradiotherapy; clinical feature; comparative study; controlled study; distant metastasis; distant metastasis free survival; female; follow up; human; local recurrence free survival; major clinical study; outcome assessment; overall survival; Papanicolaou test; priority journal; progression free survival; radiation dose; retrospective study; treatment response; uterine cervix adenocarcinoma; uterine cervix adenosquamous carcinoma; uterine cervix carcinoma; uterine cervix cytology; Adenocarcinoma; adenosquamous carcinoma; cervix; radiotherapy; squamous cell carcinoma; Adenocarcinoma; Antineoplastic Agents; Carcinoma, Adenosquamous; Carcinoma, Squamous Cell; Cervix Uteri; Chemoradiotherapy; Cisplatin; Female; Follow-Up Studies; Humans; Neoplasm Staging; Prognosis; Radiotherapy Dosage; Retrospective Studies; Survival Analysis; Treatment Failure; Uterine Cervical Neoplasms
Publisher
Wiley-Blackwell Publishing Ltd
Type
journal article