OJOG  Vol.4 No.14 , October 2014
Outcomes and Prognostic Factors for Adenocarcinoma/Adenosquamous Carcinomas Treated with Radical Hysterectomy and Adjuvant Therapy
ABSTRACT
Objective: To determine outcomes and prognostic factors for early-stage cervical adenocarcinoma/ adenosquamous carcinomas (AC/ASC) patients who are treated with radical hysterectomy and adjuvant therapy to optimize their treatment. Methods: We retrospectively reviewed the medical records of 26 patients with International Federation of Gynecologists and Obstetricians stage IB-IIB cervical AC/ASC who were treated with radical hysterectomy and adjuvant therapy. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method and compared using the log-rank test. The prognostic significance of various clinical features was determined by using multivariate analysis with the Cox proportional hazards regression model. Results: Univariate analysis revealed that OS was significantly shorter in patients with lymph node metastasis and lymphovascular space invasion. Similarly, PFS was significantly shorter for patients with lymph node metastasis and parametrial invasion. Furthermore, multivariate analysis showed that lymph node metastasis was the only independent predictor for PFS (hazard ratio: 6.47, 95% confidence interval: 1.33 - 31.44, p = 0.021). However, the use of adjuvant chemoradiotherapy did not have any significant effect on either OS or PFS, regardless of lymph node metastasis. Conclusions: Lymph node metastasis is an independent prognostic factor for poor survival in cervical AC/ASC patients treated with radical hysterectomy and adjuvant therapy. In addition, adjuvant chemoradiotherapy does not improve their survival, regardless of lymph node metastasis, which suggests that novel or personalized adjuvant therapeutic strategies with fewer adverse effects than existing strategies are needed.

Cite this paper
Yamaguchi, M. , Yamagishi, Y. , Nishikawa, N. , Sekine, M. , Serikawa, T. , Kashima, K. and Enomoto, T. (2014) Outcomes and Prognostic Factors for Adenocarcinoma/Adenosquamous Carcinomas Treated with Radical Hysterectomy and Adjuvant Therapy. Open Journal of Obstetrics and Gynecology, 4, 909-915. doi: 10.4236/ojog.2014.414128.
References
[1]   Sherman, M.E., Wang, S.S., Carreon, J. and Devesa, S.S. (2005) Mortality Trends for Cervical Squamous and Adenocarcinoma in the United States. Relation to Incidence and Survival. Cancer, 103, 1258-1264. http://dx.doi.org/10.1002/cncr.20877

[2]   Bray, F., Carstensen, B., M?ller, H., Zappa, M., Zakelj, M.P., Lawrence, G., Hakama, M. and Weiderpass, E. (2005) Incidence Trends of Adenocarcinoma of the Cervix in 13 European Countries. Cancer Epidemiology, Biomarkers & Prevention, 14, 2191-2199. http://dx.doi.org/10.1158/1055-9965.EPI-05-0231

[3]   Kurman, R.J., Ellenson, L.H. and Ronnett, B.M. (2011) Blaustein’s Pathology of the Female Tract. 6th Edition, Springer, New York, 273-274. http://dx.doi.org/10.1007/978-1-4419-0489-8

[4]   Look, K.Y., Brunetto, V.L., Clarke-Pearson, D.L., Averette, H.E., Major, F.J., Alvarez, R.D., Homesley, H.D. and Zaino, R.J. (1996) An Analysis of Cell Type in Patients with Surgically Staged Stage IB Carcinoma of the Cervix: A Gynecologic Oncology Group Study. Gynecologic Oncology, 63, 304-311. http://dx.doi.org/10.1006/gyno.1996.0327

[5]   Eifel, P.J., Burke, T.W., Morris, M. and Smith, T.L. (1995) Adenocarcinoma as an Independent Risk Factor for Disease Recurrence in Patients with Stage IB Cervical Carcinoma. Gynecologic Oncology, 59, 38-44. http://dx.doi.org/10.1006/gyno.1995.1265

[6]   ACOG Practice Bulletin No. 35 (2002) Diagnosis and Treatment of Cervical Carcinomas. Obstetrics &Gynecology, 99, 855-867.

[7]   (2013) NCCN Clinical Practice Guidelines in Oncology Cervical Cancer Version 3.
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

[8]   (2013) National Cancer Institute Cervical Cancer Treatment (PDQ?) Health Professional Version. http://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional

[9]   Kato, T., Watari, H., Takeda, M., Hosaka, M., Mitamura, T., Kobayashi, N., Sudo, S., Kaneuchi, M., Kudo, M. and Sakuragi, N. (2013) Multivariate Prognostic Analysis of Adenocarcinoma of the Uterine Cervix Treated with Radical Hysterectomy and Systematic Lymphadenectomy. Journal of Gynecologic Oncology, 24, 222-228. http://dx.doi.org/10.3802/jgo.2013.24.3.222

[10]   Lai, C.H., Hsueh, S., Hong, J.H., Chang, T.C., Tseng, C.J., Chou, H.H., Huang, K.G. and Lin, J.D. (1999) Are Adenocarcinomas and Adenosquamous Carcinomas Different from Squamous Carcinomas in Stage IB and II Cervical Cancer Patients Undergoing Primary Radical Surgery? International Journal of Gynecological Cancer, 9, 28-36. http://dx.doi.org/10.1046/j.1525-1438.1999.09895.x

[11]   Huang, Y.T., Wang, C.C., Tsai, C.S., Lai, C.H., Chang, T.C., Chou, H.H., Hsueh, S., Chen, C.K., Lee, S.P. and Hong, J.H. (2011) Long-Term Outcome and Prognostic Factors for Adenocarcinoma/Adenosquamous Carcinoma of Cervix after Definitive Radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 80, 429-436.
http://dx.doi.org/10.1016/j.ijrobp.2010.02.009

[12]   Ayhan, A., Al, R.A., Baykal, C., Demirtas, E., Yüce, K. and Ayhan, A. (2004) A Comparison of Prognoses of FIGO Stage IB Adenocarcinoma and Squamous Cell Carcinoma. International Journal of Gynecological Cancer, 14, 279-285. http://dx.doi.org/10.1111/j.1048-891X.2004.014211.x

[13]   Kasamatsu, T., Onda, T., Sawada, M., Kato, T., Ikeda, S., Sasajima, Y. and Tsuda, H. (2009) Radical Hysterectomy for FIGO Stage I-IIB Adenocarcinoma of the Uterine Cervix. British Journal of Cancer, 100, 1400-1405. http://dx.doi.org/10.1038/sj.bjc.6605048

[14]   Aoki, Y., Sato, T., Watanabe, M., Sasaki, M., Tsuneki, I. and Tanaka, K. (2001) Neoadjuvant Chemotherapy Using Low-Dose Consecutive Intraarterial Infusions of Cisplatin Combined with 5-Fluorouracil for Locally Advanced Cervical Adenocarcinoma. Gynecologic Oncology, 81, 496-499. http://dx.doi.org/10.1006/gyno.2001.6195

[15]   Tang, J., Tang, Y., Yang, J. and Huang, S. (2012) Chemoradiation and Adjuvant Chemotherapy in Advanced Cervical Adenocarcinoma. Gynecologic Oncology, 125, 297-302.
http://dx.doi.org/10.1016/j.ygyno.2012.01.033

[16]   Piver, M.S., Rutledge, F. and Smith, J.P. (1974) Five Classes of Extended Hysterectomy for Women with Cervical Cancer. Obstetrics &Gynecology, 44, 265-272.

[17]   Baalbergen, A., Ewing-Graham, P.C., Hop, W.C., Struijk, P. and Helmerhorst, T.J. (2004) Prognostic Factors in Adenocarcinoma of the Uterine Cervix. Gynecologic Oncology, 92, 262-267.
http://dx.doi.org/10.1016/j.ygyno.2003.09.001

[18]   Shingleton, H.M., Bell, M.C., Fremgen, A., Chmiel, J.S., Russell, A.H., Jones, W.B., Winchester, D.P. and Clive, R.E. (1995) Is There Really a Difference in Survival of Women with Squamous Cell Carcinoma, Adenocarcinoma, and Adenosquamous Cell Carcinoma of the Cervix? Cancer, 76, 1948-1955.

[19]   Rotman, M., Sedlis, A., Piedmonte, M.R., Bundy, B., Lentz, S.S., Muderspach, L.I. and Zaino, R.J. (2006) A Phase III Randomized Trial of Postoperative Pelvic Irradiation in Stage IB Cervical Carcinoma with Poor Prognostic Features: Follow-Up of a Gynecologic Oncology Group Study. International Journal of Radiation Oncology, Biology, Physics, 65, 169-176.
http://dx.doi.org/10.1016/j.ijrobp.2005.10.019

[20]   Peters 3rd, W.A., Liu, P.Y., Barrett 2nd, R.J., Stock, R.J., Monk, B.J., Berek, J.S., Souhami, L., Grigsby, P., Gordon Jr., W. and Alberts, D.S. (2000) Concurrent Chemotherapy and Pelvic Radiation Therapy Compared with Pelvic Radiation Therapy Alone as Adjuvant Therapy after Radical Surgery in High-Risk Early-Stage Cancer of the Cervix. Journal of Clinical Oncology, 18, 1606-1613.

[21]   Chen, Y.L., Ho, C.M., Chen, C.A., Chiang, Y.C., Huang, C.Y., Hsieh, C.Y. and Cheng, W.F. (2011) Impact of Various Treatment Modalities on the Outcome of Stage IB1-IIA Cervical Adenocarcinoma. International Journal of Gynaecology & Obstetrics, 112, 135-139.
http://dx.doi.org/10.1016/j.ijgo.2010.08.016

[22]   Huang, Y.T., Wang, C.C., Tsai, C.S., Lai, C.H., Chang, T.C., Chou, H.H., Lee, S.P. and Hong, J.H. (2012) Clinical Behaviors and Outcomes for Adenocarcinoma or Adenosquamous Carcinoma of Cervix Treated by Radical Hysterectomy and Adjuvant Radiotherapy or Chemoradiotherapy. International Journal of Radiation Oncology, Biology, Physics, 84, 420-427.
http://dx.doi.org/10.1016/j.ijrobp.2011.12.013

[23]   Mabuchi, S., Okazawa, M., Matsuo, K., Kawano, M., Suzuki, O., Miyatake, T., Enomoto, T., Kamiura, S., Ogawa, K. and Kimura, T. (2012) Impact of Histological Subtype on Survival of Patients with Surgically-Treated Stage IA2-IIB Cervical Cancer: Adenocarcinoma versus Squamous Cell Carcinoma. Gynecologic Oncology, 127, 114-120. http://dx.doi.org/10.1016/j.ygyno.2012.06.021

[24]   Park, J.Y., Kim, D.Y., Kim, J.H., Kim, Y.M., Kim, Y.T. and Nam, J.H. (2010) Outcomes after Radical Hysterectomy in Patients with Early-Stage Adenocarcinoma of Uterine Cervix. British Journal of Cancer, 102, 1692-1698. http://dx.doi.org/10.1038/sj.bjc.6605705

 
 
Top