Factors predicting disease outcome in early stage adenocarcinoma of the uterine cervix

Abstract

Context: Adenocarcinoma (AC) and adenosquamous carcinoma (ASC) comprise the second principal histological types of cervical carcinoma. As compared with the squamous cell cancer (SCC), these lesions are far less frequent, and their epidemiology, natural history and prognostic determinants are less well understood. Objective: Patients with an early stage AC of the uterine cervix diagnosed in our clinic were subjected to detailed analysis for the prognostic determinants. Study subjects: A series of 94 women with early stage (adenocarcinoma in situ (AIS) to IIB) cervical ACs or ASCs diagnosed and treated in our department during 1995–1999 and subsequently followed-up for a mean of 43.1±16.2 (S.D.) months. Main outcome measures: Patients were examined by colposcopy, Papanicolaou (PAP) smear and biopsy. The stage of the disease (FIGO) and tumour histology in operative specimens were recorded, and univariate (Kaplan–Meier) and multivariate survival analysis (Cox) were run to explore the factors predicting disease outcome. Results: Mean age of the women was 44.2±2.5 (S.D.) years (range 24–81 years), which is significantly ( P=0.000) lower than that (49.9±14.2) of 464 SCC patients in our material. Minority of the women (38.2%) reported any clinical symptoms, but these correlated with the stage ( P=0.041). Screening history was acceptable (i.e. screening interval 3 to 4 years) in 56 women, whereas 28 (29.8%) had no previous PAP smear taken. Interpretation errors were established in 17 (23.6%) and sampling errors in 6 (8.3%) of the 72 smears available for re-screening. No colposcopic lesions were found in 29 (30.9%) women. Follow-up data were available from 72 patients, of whom the disease progressed in four (one died), wheras 68 patients are alive and well at the moment. Patient’s age ( P=0.000), screening history ( P=0.0127), FIGO stage ( P=0.001), mode of therapy ( P=0.0187), and presence of co-existent squamous cell lesions ( P=0.0184) were significant prognostic indicators in univariate survival analysis. Cox’s multivariate survival analysis disclosed FIGO stage ( P=0.001) and screening history ( P=0.006) as the only significant independent predictors of the disease outcome. Conclusions: The present data emphasise the importance of early cervical AC as a disease of younger women, making early detection of its precursors (AIS) by regular PAP smear screening mandatory in prevention of disease progression. This can only be achieved by increasing the sensitivity of the PAP smear in detecting abnormal glandular cells in asymptomatic women.