Objectives The frequency of adenocarcinoma (AC) of the uterine cervix, although considered a rare entity, increased over the last 4 decades and, nothwithstanding previous studies reported a worse outcome compared to squamous cell carcinoma (SCC), standard treatment remains identical. Insight in the impact of histological types on biological behavior and pathological complete response rates might result in a treatment paradigm shift.
Methods Beginning with 548 locally advanced cervical cancer (LACC) patients submitted to chemoradiation (CTRT) plus radical surgery (RS), propensity score matching resulted in 320 cases (240 in the SCC and 80 in the AC group), balanced for age, grade, stage and lymph node status.
Results AC and SCC groups did not differ in terms of baseline characteristics as well as rates of surgical camplications. Pathological response rates to CTRT were significantly lower in the ADC vs SCC arm with complete response rates of 20% vs 36.2% (p=0.001). AC showed worse survival outcomes with median disease-free survival (DFS) of 119.5 vs 151.6 months (p=0.019) and median overall survival (OS) of 134.5 vs 162.9 months (p=0.048) in AC vs SCC, respectively. In the multivariate analysis, AC histotype (RR=1.939;p=0.005), nodal status at imaging (RR=1.769; p<0.001), and stage III or greater (RR=2.172;p=0.003) were associated with worse DFS, whereas only stage and nodal status at imaging were independent risk factor for poorer OS.
Conclusions The lower response rate to chemoradiation and the higher independent risk of recurrence showed by AC with respect to SCC patients could be useful to tailor different therapeutic strategies for LACC according to histotype.
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