Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer

doi:10.1016/j.ygyno.2012.01.034

Gynecologic Oncology

Volume 125, Issue 2, May 2012, Pages 292-296

https://doi.org/10.1016/j.ygyno.2012.01.034 Get rights and content

Abstract

Objective

To compare the treatment outcomes between squamous cell carcinoma (SCC) and adenocarcinoma (ACA) in locally advanced cervical cancer patients.

Methods

All medical records of stages IIB–IVA of cervical cancer patients who had completed treatment between 1995 and 2008 were reviewed. ACA 1 case was matched for SCC 2 cases with clinical stage, tumor size, treatment modalities (radiation therapy (RT) vs concurrent chemoradiation (CCRT)). Treatment outcomes including response to RT/CCRT, time to complete response (CR), patterns of treatment failure and survival outcomes were analyzed.

Results

A total of 423 patients with stages IIB–IVA (141 ACA: 282 SCC) were included. Most of the patients (about 60%) had stage IIB. The overall complete responses (CR) between ACA and SCC were 86.5% and 94.7%, respectively (p = 0.004). Median time to clinical CR from RT/CCRT of ACA were 2 months (0–5 months) compared with 1 month (0–4 months) for SCC (p = 0.001). Pelvic recurrence and distant failure were found in 2.1% and 14.9% in ACA, and corresponding with 3.9% and 15.6% in SCC. The 5-year overall survival rates of ACA compared to SCC were 59.9% and 61.7% (p = 0.191), respectively. When all prognostic factors are adjusted, clinical staging was the only factor that influenced overall survival.

Conclusion

ACA in locally advanced cervical cancer had poorer response rate from treatment and also used longer time to achieve CR than SCC. However, these effects were not determinants of survival outcomes.

Highlights

► Squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer were compared about treatment outcomes. ► Adenocarcinoma had more radioresistance than squamous cell carcinoma. ► Patterns of treatment failure and five-year overall survival were not different.

Introduction

Cervical cancer is the third most common cancer in women worldwide [1]. However, in the developing countries including Thailand, this cancer is still one of the leading causes of death. In addition, most of the new cases present advanced stages [2], likely because of poor access to screening programs. Clinical staging at diagnosis remains the most important determinant of survival. Standard treatment for locally advanced diseases (stage IIB to IVA) is concurrent chemoradiation (CCRT), which is proved to be more efficient than radiation therapy (RT) alone in terms of survival benefit [3], [4], [5].

Squamous cell carcinoma (SCC) is the most common histopathology of all invasive cervical cancer and accounts approximately for 80%. The effectiveness of screening programs leads to gradual decline of invasive cancer SCC incidence, while such programs fail to detect new cases of preinvasive and invasive adenocarcinoma (ACA) efficiently [6]. Therefore, an increasing proportion of ACA compared to another cell type has been reported [6], [7], [8]. Nevertheless stage-by-stage ACA and SCC are treated with the same paradigm. It is still a controversial issue whether different cell types have different patterns of failure and survival [6]. Some studies showed that ACA and SCC had no difference in survival outcomes [9], [10], but some authors reported the inferiority of treatment outcomes among ACA patients compared to SCC especially in stages I and II [11], [12] whereas Hopkins et al. [13] demonstrated that ACA had a worse 5-year overall survival (OS) rate of 15–30% compared to SCC in all stages. The rest of the cited literatures did not compare between both cell types [14], [15], [16]. Among previous randomized studies of locally advanced cervical cancer, all studies did not plan to compare outcomes between both cell types before hands [3], [4], [5], [17]. Therefore, the results of ACA from their subset analyses should be considered. Nowadays, the knowledge of clinical behavior and optimal treatment of ACA in locally advanced stages are unclear because of a limited number of patients in those stages in previous retrospective studies [9], [11], [12], [13], [14], [15], [16] as well as small number of ACA in prospective studies [3], [4], [5], [17]. The objective of this study was to determine treatment outcomes between ACA and SCC in locally advanced cervical cancer patients when the important prognostic factors and treatment modalities were matched.

Section snippets

Methods

After an approval from the Ethics Committee for Research involving Human Subjects of the institution, we reviewed the data of the Radiation Oncology Unit to identify cervical cancer patients who received treatment completely between January 1995 and December 2008. Inclusion criteria were patients who; had locally advanced stages (stages IIB to IVA) and had cell type as squamous, adenocarcinoma or adenosquamous histologies. In this study, we included adenosquamous carcinoma in adenocarcinoma

Patients' characteristics and treatment

Of all 423 patients with stages IIB–IVA, 141 who had ACA and 282 patients who had SCC were included in this study. Mean age of patients was 50.25 ± 10.65 years. More than half of the patients were in stage IIB. There were equal percent of patients in each stage between both cell types, while other factors including age, tumor size, HIV infection, and treatment modalities were comparable (Table 1). Median total treatment time (TTT) for ACA and SCC were 52.0 days (range, 43–100 days) and 50.0 days

Discussion

The interest about ACA of cervical cancer has now been increasing. During the last two decades, the incidence of ACA was up to 20% [6], [7], [18], [19], [20]. However, most data of ACA originated from the United States or western countries whose screening program is successful. There was no report in the changing of this incidence from developing countries whose screening programs were still unavailable for any women. Although ACA in cervical cancer patients had a rising of number, but the

Conflict of interest

All authors declared no conflict of interest.

Acknowledgments

We would like to express our gratitude to all staff of the Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University for their support. In addition, we thank all members of our department for sharing the information of patients' care.

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Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer

Abstract

Objective

Methods

Results

Conclusion

Highlights

Introduction

Section snippets

Methods

Patients' characteristics and treatment

Discussion

Conflict of interest

Acknowledgments

Gynecol Oncol

Gynecol Oncol

Lancet

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Am J Obstet Gynecol

Gynecol Oncol

Gynecol Oncol

Cancer Detect Prev

Eur J Surg Oncol

Int J Radiat Oncol Biol Phys

Obstet Gynecol

Gynecol Oncol

Gynecol Oncol