title: Prognostic impact of histology in patients with cervical squamous cell carcinoma, adenocarcinoma and small cell neuroendocrine carcinoma.
abstract: BACKGROUND
  Clarifying the prognostic impact of histological type is an essential issue that may influence the treatment and follow-up planning of newly diagnosed cervical cancer cases. This study aimed to evaluate the prognostic impact of histological type on survival and mortality in patients with cervical squamous cell carcinoma (SCC), adenocarcinoma (ADC) and small cell neuroendocrine carcinoma (SNEC).
  
  
  METHODS
  All patients with cervical cancer diagnosed and treated at Chiang Mai University Hospital between January 1995 and October 2011 were eligible. We included all patients with SNEC and a random weighted sample of patients with SCC and ADC. We used competing-risks regression analysis to evaluate the association between histological type and cancer-specific survival and mortality.
  
  
  RESULTS
  Of all 2,108 patients, 1,632 (77.4%) had SCC, 346 (16.4%) had ADC and 130 (6.2%) had SNEC. Overall, five-year cancer-specific survival was 60.0%, 54.7%, and 48.4% in patients with SCC, ADC and SNEC, respectively. After adjusting for other clinical and pathological factors, patients with SNEC and ADC had higher risk of cancer-related death compared with SCC patients (hazard ratio [HR] 2.6; 95% CI, 1.9-3.5 and HR 1.3; 95% CI, 1.1-1.5, respectively). Patients with SNEC were younger and had higher risk of cancer-related death in both early and advanced stages compared with SCC patients (HR 4.9; 95% CI, 2.7-9.1 and HR 2.5; 95% CI, 1.7-3.5, respectively). Those with advanced-stage ADC had a greater risk of cancer-related death (HR 1.4; 95% CI, 1.2-1.7) compared with those with advanced-stage SCC, while no significant difference was observed in patients with early stage lesions.
  
  
  CONCLUSIONS
  Histological type is an important prognostic factor among patients with cervical cancer in Thailand. Though patients with SNEC were younger and more often had a diagnosis of early stage compared with ADC and SCC, SNEC was associated with poorest survival. ADC was associated with poorer survival compared with SCC in advanced stages, while no difference was observed at early stages. Further tailored treatment-strategies and follow-up planning among patients with different histological types should be considered.
authors.affiliation: Boromarajonnani College of Nursing, Khon Kaen, Khon Kaen, Thailand E-mail : yrai250@hotmail.com.
authors.forename: Suthida
authors.initials: S
authors.lastname: Intaraphet
authors.forename: Nongyao
authors.initials: N
authors.lastname: Kasatpibal
authors.forename: Sumalee
authors.initials: S
authors.lastname: Siriaunkgul
authors.forename: Mette
authors.initials: M
authors.lastname: Sogaard
authors.forename: Jayanton
authors.initials: J
authors.lastname: Patumanond
authors.forename: Surapan
authors.initials: S
authors.lastname: Khunamornpong
authors.forename: Anchalee
authors.initials: A
authors.lastname: Chandacham
authors.forename: Prapaporn
authors.initials: P
authors.lastname: Suprasert
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000328:Adult; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology*