Clinicopathologic features and prognostic analysis of stage IB-IIA cervical adenosquamous carcinoma and adenocarcinoma

Abstract

Objective To analyze the clinicopathologic features and prognosis of early stage cervical adenosquamous carcinoma and adenocarcinoma. Methods Clinical data of 62 patients with cervical adenosquamous carcinoma, 149 patients with adenocarcinoma and 2 687 patients with squamous carcinoma of stage ⅠB-ⅡA, who received surgical treatment and adjuvant radiotherapy from June 2006 to February 2012 were retrospectively analyzed. The Chi-square test, Kaplan-Meier method, log-rank test and logistic regression were used for statistical analysis. Results In patients with adenosquamous carcinoma, adenocarcinoma and squamous carcinoma, the rates of lymph node metastasis were 33.6% (50/149), 29.0% (18/62) and 22.0% (591/2 687), deep stromal invasion were 64.4% (96/149), 75.8%(47/62) and 55.3% (1 486/2 687) and corpus invasion were 26.2%(39/149), 25.8%(16/62) and 6.7%(181/2 687), respectively. Those pathological parameters in adenosquamous carcinoma and adenocarcinoma were higher than those in squamous carcinoma (χ2=12.170, P=0.002; χ2=14.660, P=0.001; χ2=97.732, P=0.000). There were no difference between adenocarcinoma and adenosquamous carcinoma in proportion of massive tumor (≥4 cm)[38.9%(58/149) vs. 35.5(22/62), χ2=0.220, P=0.639], lymph node metastasis (χ2=0.410, P=0.522), corpus invasion (χ2=0.003, P=0.956), deep stromal invasion (χ2=2.595, P=0.107) and low differentiation[38.9%(58/149) vs. 48.4%(30/62), χ2=1.612, P=0.204]. The median follow-up period was 45 (3-92) months. Multivariate analysis showed that corpus invasion (P=0.014, RR=3.393, 95%CI: 1.280-8.991), age (P=0.000, RR=1.077, 95%CI: 1.037-1.117) and stage (P=0.007, RR=0.275, 95%CI: 0.108-0.699) were prognostic factors of adenosquamous carcinoma. Age (P=0.006, RR=1.025, 95%CI: 1.007-1.043) and lymph node metastasis (P=0.000, RR=2.525, 95%CI: 1.547-4.120) affected the prognosis of adenocarcinoma. The median survival times for adenocarcinoma, adenosquamous carcinoma and squamous carcinoma were 45, 46 and 56 months (adenosquamous carcinoma vs. squamous carcinoma: χ2=1.347, P=0.246; adenosquamous carcinoma vs. adenocarcinoma: χ2 =1.808, P=0.179). There were no difference in recurrence rates between adenosquamous carcinoma and squamous carcinoma[14.0%(7/50) vs. 7.6%(175/2 298), χ2=1.968, P=0.161], and between adenosquamous carcinoma and adenocarcinoma[14.0%(7/50) vs. 22.1%(27/122), χ2=1.478, P=0.224]. Conclusions Clinicopathologic features are similar between stage ⅠB-ⅡA cervical adenosquamous carcinoma and adenocarcinoma. Corpus invasion, age and stage are the leading indicators affecting the prognosis of adenosquamous carcinoma. Age and lymph node metastasis are the factors affecting the prognosis of adenocarcinoma. There are no difference in survival and prognosis between adenosquamous carcinoma and adenocarcinoma. Key words: Uterine cervical neoplasms; Adenocarcinoma; Adenosquamous carcinoma; Pathological conditions, signs and symptoms; Prognosis