title: Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy.
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).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  National Taiwan University Hospital, Taipei, Taiwan.
  
  
  METHODS
  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.
  
  
  METHODS
  Medical and histopathological record review.
  
  
  METHODS
  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.
authors.affiliation: Department of Oncology, National Taiwan University Hospital Yun Lin Branch, Yun-Lin, Taiwan.
authors.forename: Jenny Ling-Yu
authors.initials: JL
authors.lastname: Chen
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Huang
authors.forename: Ruey-Jien
authors.initials: RJ
authors.lastname: Chen
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Wang
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Chen
authors.forename: Jason Chia-Hsien
authors.initials: JC
authors.lastname: Cheng
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Sung-Hsin
authors.initials: SH
authors.lastname: Kuo
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002584:Cervix Uteri / Q000473:pathology*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Adenocarcinoma; adenosquamous carcinoma; cervix; radiotherapy; squamous cell carcinoma