Adjuvant therapy after radical surgery for stage IB-IIB cervical adenocarcinoma with risk factors.
OBJECTIVE
Patients with adeno/adenosquamous carcinoma may have a poorer prognosis than patients with squamous cell carcinoma. Radiotherapy and concurrent chemoradiotherapy are used as adjuvant therapies for cervical cancer, regardless of the histological subtype. The aim of this study was to investigate the prognostic outcome of adjuvant therapy for patients with adeno/adenosquamous carcinoma with pathological risk factors.


METHODS
The medical records of 135 patients with stage IB-IIB cervical cancer with squamous cell carcinoma or adeno/adenosquamous carcinoma who underwent primary surgery followed by adjuvant therapy were retrospectively reviewed. Patients with a pathologically confirmed bulky tumor (≥4 cm), nodal metastasis and/or parametrium invasion were included in the study.


RESULTS
The median follow-up period was 48 (1-132) months. Of the 135 patients, 90 with squamous cell carcinoma and 23 with adeno/adenosquamous carcinoma were treated with adjuvant radiotherapy and concurrent chemoradiotherapy (SCC-RT/CCRT and AC-RT/CCRT groups), and 22 with adeno/adenosquamous carcinoma were treated with adjuvant systemic chemotherapy (AC-CT group). There were no significant differences in clinicopathological factors between the SCC-RT/CCRT and AC-RT/CCRT groups and between the AC-RT/CCRT and AC-CT groups. Progression-free survival was significantly shorter in the AC-RT/CCRT group compared to the SCC-RT/CCRT group (P = 0.002). Adeno/adenosquamous carcinoma histology and multiple lymph node metastasis were independent prognostic factors for shorter progression-free survival in patients treated with adjuvant radiotherapy and concurrent chemoradiotherapy. Progression-free survival was also significantly shorter in the AC-RT/CCRT group compared to the AC-CT group (P = 0.026).


CONCLUSIONS
Adjuvant radiotherapy and concurrent chemoradiotherapy may be less effective for patients with adeno/adenosquamous carcinoma than for those with squamous cell carcinoma. Adjuvant systemic chemotherapy may be beneficial for adeno/adenosquamous carcinoma and further studies are warranted.
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo.
Toshiyuki
T
Seki
Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa htanabe@jikei.ac.jp.
Hiroshi
H
Tanabe
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo.|Division of Education for Clinical Research, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo.
Chie
C
Nagata
Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa.
Jiro
J
Suzuki
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo.|Department of Obstetrics and Gynecology, Dokkyo Medical University Koshigaya Hospital, Koshigaya.
Kayo
K
Suzuki
Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa.
Hirokuni
H
Takano
Department of Obstetrics and Gynecology, The Jikei University Daisan Hospital, Tokyo.
Seiji
S
Isonishi
Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Kazuhiko
K
Ochiai
Department of Obstetrics and Gynecology, Dokkyo Medical University Koshigaya Hospital, Koshigaya.
Satoshi
S
Takakura
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo.
Aikou
A
Okamoto
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*
D000970:Antineoplastic Agents
adjuvant therapy; cervical adenocarcinoma; chemotherapy; high risk cervical cancer