title: Prognostic factors and adjuvant therapy on survival in early-stage cervical adenocarcinoma/adenosquamous carcinoma after primary radical surgery: A Taiwanese Gynecologic Oncology Group (TGOG) study.
abstract: OBJECTIVE
  We aimed to identify prognostic factors of early-stage cervical adenocarcinoma (AC) and adenosquamous carcinoma (ASC) treated with primary radical surgery, and to evaluate the impact of postoperative adjuvant therapy on outcome.
  
  
  METHODS
  The clinical-pathological data of all patients (n = 1132) with stages I-II cervical AC/ASC treated with primary radical surgery at the member hospitals of the Taiwanese Gynecologic Oncology Group were retrospectively reviewed.
  
  
  RESULTS
  In multivariate analysis, stage II, deep stromal invasion (DSI), lymphovascular space invasion (LVSI), positive pelvic lymph node (PLN), and parametrial involvement (PI) were significant factors for recurrence-free survival (RFS), while only DSI, PI, and positive PLN were independent factors for cancer-specific survival (CSS). Low- and high-risk groups were defined by prognostic scores derived from the four factors (DSI, LVSI, positive PLN, PI) selected by internal validation. Postoperative adjuvant therapy significantly improved outcome for PLN-positive patients (RFS, p = 0.014; CSS, p = 0.016), but not for PLN-negative high-risk group because of higher mean prognostic score (p = 0.028) of adjuvant+ than adjuvant- patients.
  
  
  CONCLUSIONS
  PLN metastasis, PI, DSI, and LVSI were independent prognostic factors. Prospective studies of postoperative adjuvant therapy with prognostic score and nodal status stratification for cervical AC/ASC are necessary.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors: Nae-Fang
authors: NF
authors: Twu
authors: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Yu-Che
authors: YC
authors: Ou
authors: Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors: Cheng-I
authors: CI
authors: Liao
authors: Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Wei-Yang
authors: WY
authors: Chang
authors: Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Lan-Yan
authors: LY
authors: Yang
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Yun-Hsin
authors: YH
authors: Tang
authors: Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Tze-Chien
authors: TC
authors: Chen
authors: Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Chi-Hau
authors: CH
authors: Chen
authors: Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.
authors: Tze-Ho
authors: TH
authors: Chen
authors: Department of Obstetrics and Gynecology, China Medical University Hospital, China Medical University College of Medicine, Taichung, Taiwan.
authors: Lain-Shung
authors: LS
authors: Yeh
authors: Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Shih-Tien
authors: ST
authors: Hsu
authors: Department of Obstetrics and Gynecology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
authors: Yu-Chieh
authors: YC
authors: Chen
authors: Department of Obstetrics and Gynecology, Triservice General Hospital, National Defense University, Taipei, Taiwan.
authors: Cheng-Chang
authors: CC
authors: Chang
authors: Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
authors: Ya-Min
authors: YM
authors: Cheng
authors: Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Chia-Yen
authors: CY
authors: Huang
authors: Department of Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors: Fu-Shing
authors: FS
authors: Liu
authors: Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
authors: Yue-Shan
authors: YS
authors: Lin
authors: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors: Sheng-Mou
authors: SM
authors: Hsiao
authors: Department of Obstetrics and Gynecology, Yuan's General Hospital, Kaohsiung, Taiwan.
authors: Yuan-Yee
authors: YY
authors: Kan
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: sh46erry@ms6.hinet.net.
authors: Chyong-Huey
authors: CH
authors: Lai
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018196:Carcinoma, Adenosquamous / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000401:mortality*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D055815:Young Adult
keywords: Adenocarcinoma; Adenosquamous carcinoma; Adjuvant therapy; Cervical cancer; Prognostic factor