Comparison of clinical outcomes of adenocarcinoma and adenosquamous carcinoma in uterine cervical cancer patients receiving surgical resection followed by radiotherapy: a multicenter retrospective study (KROG 13-10).
OBJECTIVE
To evaluate the prognostic influence of adenocarcinoma (AC) and adenosquamous carcinoma (ASC) in patients with FIGO stage IB-IIA cervical cancer who received radical hysterectomy followed by adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).


METHODS
We analyzed 1323 patients who satisfied the following criteria: histologically proven squamous cell carcinoma (SCC), AC, or ASC of the uterine cervix; FIGO stage IB-IIA disease; no history of neoadjuvant chemotherapy; and a history of radical hysterectomy with pelvic lymph node (PLN) dissection, followed by postoperative pelvic RT at a dose ≥ 45 Gy. The median age was 50 years. Median RT dose delivered to the whole pelvis was 50.4 Gy, and 219 (16.6%) patients received brachytherapy at a median dose of 24 Gy. Concurrent chemotherapy was delivered to 492 (37.2%) patients.


RESULTS
Pathologic risk factors were not different according to pathologic subtype. The median follow-up duration was 75.7 months. Locoregional recurrence-free survival, relapse-free survival (RFS), and overall survival were significantly affected by histology, tumor size, PLN metastasis, parametrial invasion, lymphovascular invasion, and deep stromal invasion. The 5-year RFS rates were 83.7%, 66.5%, and 79.6% in patients with SCC, AC, and ASC histology, respectively (P<0.0001). By multivariate analysis, AC histology was the only significant prognostic factor affecting all survival outcomes.


CONCLUSIONS
AC histology was associated with poor survival outcomes in patients with FIGO stage IB-IIA cervical cancer who received adjuvant RT or CCRT. Prognosis of ASC histology was closer to that of SCC histology than that of AC histology.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Jae Myoung
JM
Noh
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea. Electronic address: wonro.park@samsung.com.
Won
W
Park
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
Young Seok
YS
Kim
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
Joo-Young
JY
Kim
Department of Radiation Oncology, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea.
Hak Jae
HJ
Kim
Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, 17, Seoae-ro 1-gil, Jung-gu, Seoul 100-380, Republic of Korea.
Juree
J
Kim
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, 56, Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea.
Jin Hee
JH
Kim
Department of Radiation Oncology, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-763, Republic of Korea.
Mee Sun
MS
Yoon
Department of Radiation Oncology, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul 156-755, Republic of Korea.
Jin Hwa
JH
Choi
Department of Radiation Oncology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 425-807, Republic of Korea.
Won Sup
WS
Yoon
Department of Radiation Oncology, Yeoeuido St. Mary's Hospital, The Catholic University of Korea College of Medicine, 10, 63-ro, Yeongdeungpo-gu, Seoul 150-713, Republic of Korea.
Ji-Yoon
JY
Kim
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Seung Jae
SJ
Huh
D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D055815:Young Adult
Adenocarcinoma; Adenosquamous carcinoma; Cervical cancer; Postoperative radiotherapy