Glassy cell carcinoma of the cervix (GCCC): a single institution review of treatment patterns and outcomes (184)

Abstract

Objectives: Glassy cell carcinoma of the cervix (GCCC) is a rare histologic subset of adenosquamous carcinoma of the cervix, historically considered to demonstrate aggressive clinical behavior. Given its rarity, there is a lack of standardized guidelines. We performed a retrospective review of cases incorporating updated 2018 FIGO staging to evaluate variation in treatment patterns and oncologic outcomes. Methods: This retrospective review was performed at a comprehensive cancer center from 2012 to 2020. Cases were identified through keyword search for “glassy cell” among cervical cancer patients identified by ICD code. The electronic medical record was utilized to obtain demographic, clinical, and pathologic data. Descriptive statistics and Kaplan-Meier survival analyses were performed. Results: We identified 14 cases of GCCC diagnosed between 2012 and 2020. The median age at diagnosis was 34 years, and the median BMI was 29.91. Patients were all re-staged according to the 2018 FIGO staging system for uniformity. Cases were grouped as early-stage (stage I, n=9) and advanced-stage (stage IIIC, n=5). All nine early-stage cases underwent type III radical hysterectomy (3-MIS, 6-open). Adjuvant external beam radiation with sensitizing cisplatin was given for cases meeting Sedlis criteria (4/9, 44%). The remaining 5/9 cases received no adjuvant therapy. All five advanced stage cases received definitive chemoradiation. After a median follow-up of 47 months, the recurrence rate was 0% (0/9) for early-stage and 60% (3/5) for advanced-stage cases. The median time to recurrence was four months. Chemotherapy was given for 2/3 recurrent cases as second-line treatment. Those same two cases were tested for PD-L1. Both had CPS scores >1 and received pembrolizumab subsequently, one of which had a complete response and was without evidence of disease 21 months later. The 3-year PFS was 100% for early-stage and 40% for advanced-stage. The 3-year OS was 100% for early-stage and 60% for advanced-stage. Kaplan-Meier PFS and OS curves are shown in Figure 1. Conclusions: Among patients with early-stage GCCC, the most common treatment modality was radical hysterectomy with the use of adjuvant radiation for those meeting Sedlis criteria. Overall, treatment decision-making largely mirrored NCCN guidelines for squamous cell carcinoma, adenosquamous carcinoma, and adenocarcinoma of the cervix. When staged by 2018 FIGO staging, outcomes appeared to be similar to more common types of cervical cancer for early-stage cases. However, recurrence in 60% of advanced-stage cases may indicate worse outcomes. Although limited by sample size, the high proportion of stage IIIC cases in this cohort may indicate an overall higher stage at presentation or perhaps a propensity for lymph node metastasis. The patient with a complete and durable response after treatment with pembrolizumab highlights the importance of assessing for biomarkers that may identify candidates for immunotherapy or other newer treatment modalities. Objectives: Glassy cell carcinoma of the cervix (GCCC) is a rare histologic subset of adenosquamous carcinoma of the cervix, historically considered to demonstrate aggressive clinical behavior. Given its rarity, there is a lack of standardized guidelines. We performed a retrospective review of cases incorporating updated 2018 FIGO staging to evaluate variation in treatment patterns and oncologic outcomes. Methods: This retrospective review was performed at a comprehensive cancer center from 2012 to 2020. Cases were identified through keyword search for “glassy cell” among cervical cancer patients identified by ICD code. The electronic medical record was utilized to obtain demographic, clinical, and pathologic data. Descriptive statistics and Kaplan-Meier survival analyses were performed. Results: We identified 14 cases of GCCC diagnosed between 2012 and 2020. The median age at diagnosis was 34 years, and the median BMI was 29.91. Patients were all re-staged according to the 2018 FIGO staging system for uniformity. Cases were grouped as early-stage (stage I, n=9) and advanced-stage (stage IIIC, n=5). All nine early-stage cases underwent type III radical hysterectomy (3-MIS, 6-open). Adjuvant external beam radiation with sensitizing cisplatin was given for cases meeting Sedlis criteria (4/9, 44%). The remaining 5/9 cases received no adjuvant therapy. All five advanced stage cases received definitive chemoradiation. After a median follow-up of 47 months, the recurrence rate was 0% (0/9) for early-stage and 60% (3/5) for advanced-stage cases. The median time to recurrence was four months. Chemotherapy was given for 2/3 recurrent cases as second-line treatment. Those same two cases were tested for PD-L1. Both had CPS scores >1 and received pembrolizumab subsequently, one of which had a complete response and was without evidence of disease 21 months later. The 3-year PFS was 100% for early-stage and 40% for advanced-stage. The 3-year OS was 100% for early-stage and 60% for advanced-stage. Kaplan-Meier PFS and OS curves are shown in Figure 1. Conclusions: Among patients with early-stage GCCC, the most common treatment modality was radical hysterectomy with the use of adjuvant radiation for those meeting Sedlis criteria. Overall, treatment decision-making largely mirrored NCCN guidelines for squamous cell carcinoma, adenosquamous carcinoma, and adenocarcinoma of the cervix. When staged by 2018 FIGO staging, outcomes appeared to be similar to more common types of cervical cancer for early-stage cases. However, recurrence in 60% of advanced-stage cases may indicate worse outcomes. Although limited by sample size, the high proportion of stage IIIC cases in this cohort may indicate an overall higher stage at presentation or perhaps a propensity for lymph node metastasis. The patient with a complete and durable response after treatment with pembrolizumab highlights the importance of assessing for biomarkers that may identify candidates for immunotherapy or other newer treatment modalities.