Skip to main content

Advertisement

SpringerLink
Log in

Comparison of clinical outcomes of squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the uterine cervix after definitive radiotherapy: a population-based analysis

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the clinical outcomes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to IVA squamous cell carcinoma (SCC), adenocarcinoma (AC), and adenosquamous carcinoma (ASC) of the uterine cervix after definitive radiotherapy.

Methods

Patients with a primary diagnosis of FIGO stage I–IVA SCC, AC, and ASC of the uterine cervix who had undergone definitive beam radiation with implants or isotopes between 1988 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression analyses were performed to analyze the effect of histologic subtype on cause-specific survival (CSS) and overall survival (OS).

Results

A total of 8751 were identified, and 86.0, 10.6, and 3.4 % of patients were SCC, AC, and ASC, respectively. AC patients were more often well differentiated, while more patients were poorly/undifferentiated in ASC subtype. A higher percentage of AC and ASC patients were stage I, and fewer had stage III compared to SCC. Univariate and multivariate Cox analyses showed that histologic subtype was an independent prognostic factor for CSS and OS. SCC subtype had a better CSS and OS compared to AC and ASC subtype. The survival between AC and ASC had no significant difference. The impact of the histologic subtype on CSS and OS was not affected by FIGO stage and the year of diagnosis.

Conclusion

AC and ASC subtypes are independent prognostic factors for cervical cancer patients treated with definitive radiotherapy. AC and ASC subtypes are associated with poor survival outcomes than those with SCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Baek MH, Park JY, Kim D, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH (2014) Comparison of adenocarcinoma and adenosquamous carcinoma in patients with early-stage cervical cancer after radical surgery. Gynecol Oncol 135(3):462–467

    Article  PubMed  Google Scholar 

  • Chen JL, Huang CY, Huang YS, Chen RJ, Wang CW, Chen YH, Cheng JC, Cheng AL, Kuo SH (2014) Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy. Acta Obstet Gynecol Scand 93(7):661–668

    Article  PubMed  Google Scholar 

  • Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66(2):115–132

    Article  PubMed  Google Scholar 

  • dos Reis R, Frumovitz M, Milam MR, Capp E, Sun CC, Coleman RL, Ramirez PT (2007) Adenosquamous carcinoma versus adenocarcinoma in early-stage cervical cancer patients undergoing radical hysterectomy: an outcomes analysis. Gynecol Oncol 107(3):458–463

    Article  PubMed  Google Scholar 

  • Harrison TA, Sevin BU, Koechli O, Nguyen HN, Averette HE, Penalver M, Donato DM, Nadji M (1993) Adenosquamous carcinoma of the cervix: prognosis in early stage disease treated by radical hysterectomy. Gynecol Oncol 50(3):310–315

    Article  CAS  PubMed  Google Scholar 

  • Hsu HC, Li X, Curtin JP, Goldberg JD, Schiff PB (2015) Surveillance epidemiology and end results analysis demonstrates improvement in overall survival for cervical cancer patients treated in the era of concurrent chemoradiotherapy. Front Oncol 5:81

    Article  PubMed  PubMed Central  Google Scholar 

  • Huang YT, Wang CC, Tsai CS, Lai CH, Chang TC, Chou HH, Hsueh S, Chen CK, Lee SP, Hong JH (2011) Long-term outcome and prognostic factors for adenocarcinoma/adenosquamous carcinoma of cervix after definitive radiotherapy. Int J Radiat Oncol Biol Phys 80(2):429–436

    Article  PubMed  Google Scholar 

  • Huang YT, Wang CC, Tsai CS, Lai CH, Chang TC, Chou HH, Lee SP, Hong JH (2012) Clinical behaviors and outcomes for adenocarcinoma or adenosquamous carcinoma of cervix treated by radical hysterectomy and adjuvant radiotherapy or chemoradiotherapy. Int J Radiat Oncol Biol Phys 84(2):420–427

    Article  PubMed  Google Scholar 

  • Imadome K, Iwakawa M, Nakawatari M, Fujita H, Kato S, Ohno T, Nakamura E, Ohkubo Y, Tamaki T, Kiyohara H, Imai T (2010) Subtypes of cervical adenosquamous carcinomas classified by EpCAM expression related to radiosensitivity. Cancer Biol Ther 10(10):1019–1026

    Article  PubMed  Google Scholar 

  • Kasamatsu T, Onda T, Sawada M, Kato T, Ikeda S, Sasajima Y, Tsuda H (2009) Radical hysterectomy for FIGO stage I-IIB adenocarcinoma of the uterine cervix. Br J Cancer 100(9):1400–1405

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Katanyoo K, Sanguanrungsirikul S, Manusirivithaya S (2012) Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer. Gynecol Oncol 125(2):292–296

    Article  PubMed  Google Scholar 

  • Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL 3rd, Walker JL, Gersell D (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340(15):1154–1161

    Article  CAS  PubMed  Google Scholar 

  • Kim YB, Kim GE, Pyo HR, Cho NH, Keum KC, Lee CG, Seong J, Suh CO, Park TK (2004) Differential cyclooxygenase-2 expression in squamous cell carcinoma and adenocarcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 60(3):822–829

    Article  CAS  PubMed  Google Scholar 

  • Kosary CL (1994) FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973-87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina. Semin Surg Oncol 10(1):31–46

    Article  CAS  PubMed  Google Scholar 

  • Lee YY, Choi CH, Kim TJ, Lee JW, Kim BG, Lee JH, Bae DS (2011) Comparison of pure adenocarcinoma and squamous cell carcinoma of the cervix after radical hysterectomy in stage IB-IIA. Gynecol Oncol 120(3):439–443

    Article  PubMed  Google Scholar 

  • Lee JY, Lee C, Hahn S, Kim MA, Kim HS, Chung HH, Kim JW, Park NH, Song YS (2014) Prognosis of adenosquamous carcinoma compared with adenocarcinoma in uterine cervical cancer: a systematic review and meta-analysis of observational studies. Int J Gynecol Cancer 24(2):289–294

    Article  PubMed  Google Scholar 

  • Lee JY, Kim YT, Kim S, Lee B, Lim MC, Kim JW, Won YJ (2015) Prognosis of cervical cancer in the era of concurrent chemoradiation from national database in Korea: a comparison between squamous cell carcinoma and adenocarcinoma. PLoS ONE 10(12):e0144887

    Article  PubMed  PubMed Central  Google Scholar 

  • Mabuchi S, Okazawa M, Kinose Y, Matsuo K, Fujiwara M, Suzuki O, Morii E, Kamiura S, Ogawa K, Kimura T (2012a) Comparison of the prognoses of FIGO stage I to stage II adenosquamous carcinoma and adenocarcinoma of the uterine cervix treated with radical hysterectomy. Int J Gynecol Cancer 22(8):1389–1397

    Article  PubMed  Google Scholar 

  • Mabuchi S, Okazawa M, Matsuo K, Kawano M, Suzuki O, Miyatake T, Enomoto T, Kamiura S, Ogawa K, Kimura T (2012b) Impact of histological subtype on survival of patients with surgically-treated stage IA2-IIB cervical cancer: adenocarcinoma versus squamous cell carcinoma. Gynecol Oncol 127(1):114–120

    Article  PubMed  Google Scholar 

  • Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, Rotman M, Gershenson DM, Mutch DG (1999) Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 340(15):1137–1143

    Article  CAS  PubMed  Google Scholar 

  • Moyses HM, Morrow CP, Muderspach LI, Roman LD, Vasilev SA, Petrovich Z, Groshen SL, Klement V (1996) Residual disease in the uterus after preoperative radiotherapy and hysterectomy in stage IB cervical carcinoma. Am J Clin Oncol 19(5):433–438

    Article  CAS  PubMed  Google Scholar 

  • Nakamura E, Iwakawa M, Furuta R, Ohno T, Satoh T, Nakawatari M, Ishikawa K, Imadome K, Michikawa Y, Tamaki T, Kato S, Kitagawa T, Imai T (2009) Villin1, a novel diagnostic marker for cervical adenocarcinoma. Cancer Biol Ther 8(12):1146–1153

    Article  CAS  PubMed  Google Scholar 

  • National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed on 14 Aug 2016

  • Noh JM, Park W, Kim YS, Kim JY, Kim HJ, Kim J, Kim JH, Yoon MS, Choi JH, Yoon WS, Kim JY, Huh SJ (2014) 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). Gynecol Oncol 132(3):618–623

    Article  PubMed  Google Scholar 

  • Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH (2010) Outcomes after radical hysterectomy in patients with early-stage adenocarcinoma of uterine cervix. Br J Cancer 102(12):1692–1698

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS (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. J Clin Oncol 18(8):1606–1613

    CAS  PubMed  Google Scholar 

  • Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340(15):1144–1153

    Article  CAS  PubMed  Google Scholar 

  • Rose PG, Java JJ, Whitney CW, Stehman FB, Lanciano R, Thomas GM (2014) Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in gynecologic oncology group trials of cisplatin-based chemoradiation. Gynecol Oncol 135(2):208–212

    Article  PubMed  PubMed Central  Google Scholar 

  • Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30

    Article  PubMed  Google Scholar 

  • Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 9 Regs Research Data, Nov 2015 Sub (1973–2013) <Katrina/Rita Population Adjustment> —Linked To County Attributes—Total US, 1969–2014 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2016, based on the November 2015 submission

  • Teke F, Yoney A, Teke M, Inal A, Urakci Z, Eren B, Zincircioglu SB, Buyukpolat MY, Ozer A, Isikdogan A, Unsal M (2014) Lack of any impact of histopathology type on prognosis in patients with early-stage adenocarcinoma and squamous cell carcinoma of the uterine cervix. Asian Pac J Cancer Prev 15(6):2815–2859

    Article  PubMed  Google Scholar 

  • Torre LA, Siegel RL, Ward EM, Jemal A (2016) Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiol Biomark Prev 25(1):16–27

    Article  Google Scholar 

  • Vinh-Hung V, Bourgain C, Vlastos G, Cserni G, De Ridder M, Storme G, Vlastos AT (2007) Prognostic value of histopathology and trends in cervical cancer: a SEER population study. BMC Cancer 7:164

    Article  PubMed  PubMed Central  Google Scholar 

  • Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, Clarke-Pearson DL, Liao SY (1999) Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy instage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Groupand Southwest Oncology Group study. J Clin Oncol 17(5):1339–1348

    CAS  PubMed  Google Scholar 

  • Winer I, Alvarado-Cabrero I, Hassan O, Ahmed QF, Alosh B, Bandyopadhyay S, Thomas S, Albayrak S, Talukdar S, Al-Wahab Z, Elshaikh MA, Munkarah A, Morris R, Ali-Fehmi R (2015) The prognostic significance of histologic type in early stage cervical cancer—a multi-institutional study. Gynecol Oncol 137(3):474–478

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from the National Natural Science Foundation of China (No. 81571418), the Natural Science Foundation of Fujian Province (Nos. 2015J01550, 2013D001), and the Foundation for Young Scholar of Fujian Provincial Health Department (No. 2014-ZQN-ZD-31).

Author information

Author notes

    Authors and Affiliations

    1. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People’s Republic of China

      Juan Zhou & Qiong-Hua Chen

    2. Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People’s Republic of China

      San-Gang Wu

    3. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People’s Republic of China

      Jia-Yuan Sun, Feng-Yan Li, Huan-Xin Lin & Zhen-Yu He

    Authors
    1. Juan Zhou
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. San-Gang Wu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jia-Yuan Sun
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Feng-Yan Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Huan-Xin Lin
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Qiong-Hua Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Zhen-Yu He
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Qiong-Hua Chen or Zhen-Yu He.

    Ethics declarations

    Conflict of interest

    The authors declare that there are no conflicts of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

    Informed consent

    We obtained permission to access SEER research data files with the reference number 10269-Nov2015. Extraction of data from the SEER database does not require informed consent.

    Additional information

    Juan Zhou and San-Gang Wu have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhou, J., Wu, SG., Sun, JY. et al. Comparison of clinical outcomes of squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the uterine cervix after definitive radiotherapy: a population-based analysis. J Cancer Res Clin Oncol 143, 115–122 (2017). https://doi.org/10.1007/s00432-016-2246-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00432-016-2246-9

    Keywords

    Search

    Navigation