Seo, Jun-HyeongJun-HyeongSeoYang, Tyan-ShinTyan-ShinYangKim, Hyun-SooHyun-SooKimCho, Won KyungWon KyungChoLAI YEN-LINGJUNG CHENYU-LI CHENLee, Yoo-YoungYoo-YoungLee2025-03-202025-03-202025-02-18https://scholars.lib.ntu.edu.tw/handle/123456789/725892Objective: To evaluate the prognostic impact of primary surgery on patients with HPV-independent, advanced or metastatic endocervical adenocarcinoma (EAC) who typically exhibit poor survival outcomes and resistance to conventional therapies such as chemoradiotherapy. Methods: A bi-institutional retrospective study was conducted at Samsung Medical Center and Taiwan National University Hospital. Between 2001 and 2023, 92 patients with HPV-independent advanced or metastatic EAC were included. Patients were divided into two groups: 54 (58.7%) underwent primary surgery and 38 (41.3%) received non-surgical treatments, including definitive radiotherapy or palliative chemotherapy. Kaplan–Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors. Results: The surgery group demonstrated significantly improved outcomes, with a median PFS of 19.2 months, compared with 10.0 months in the non-surgery group (P < 0.001). Median OS was not reached in the surgery group, whereas it was 24.1 months in the non-surgery group (P = 0.002). Multivariate analysis showed that non-surgical treatment was an independent predictor of poor PFS (hazard ratio [HR] 2.25; 95% confidence interval [CI] 1.18–4.29; P = 0.013) and OS (HR 3.25; 95% CI 1.37–7.73; P = 0.008). Additionally, the recurrence rate was significantly lower in the surgery group (55.6%) than in the non-surgery group (84.2%; P = 0.006). Conclusion: Primary surgery significantly improves survival outcomes in patients with HPV-independent advanced or metastatic EAC. These findings suggest that surgery should be considered as part of a multimodal treatment strategy for this aggressive subtype, highlighting the need for individualized therapeutic approaches beyond standard chemoradiotherapy protocols.enchemoradiotherapyendocervical adenocarcinomahuman papillomavirussurgery[SDGs]SDG3journal article10.1002/ijgo.7002839963791