Outcomes of Definitive Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma and Adenocarcinoma: Overall Survival, Locoregional Recurrence, and Distant Metastasis

Abstract

PURPOSE: To estimate the outcomes of definitive concurrent chemoradiotherapy (CCRT) for bulky or advanced-stage cervical squamous cell carcinoma (SCC) and adenocarcinoma (ADC). PATIENTS AND METHODS: We enrolled patients who had been diagnosed as having cervical SCC or ADC and received definitive CCRT between January 1, 2007, and December 31, 2015. A Cox regression analysis was performed to determine the hazard ratio (HR) and 95% confidence intervals (95% CI); independent predictors were stratified or controlled for in the analysis, and the endpoint was all-cause mortality among patients with cervical SCC and ADC who received CCRT. Propensity score matching was performed to create well-balanced groups. RESULTS: We enrolled 3258 patients who had International Federation of Gynecology and Obstetrics (FIGO) stage IB2–IVA cervical cancer without distant metastasis. Among them, 2927 patients with cervical SCC and 331 patients with cervical ADC received definitive CCRT. The results of multivariate Cox regression analysis indicated that ADC, advanced FIGO stage, no intracavitary brachytherapy, old age, earlier year of diagnosis, and higher comorbidity scores were significant independent poor prognostic factors of all-cause mortality in patients with cervical cancer who received definitive CCRT. Patients with cervical ADC who received definitive CCRT had higher all-cause mortality, locoregional recurrence (LRR), and distant metastasis (DM) (adjusted HR [95% CI]: 2.10 [1.79–2.46], 1.79 [1.35–2.37], and 1.97 [1.54–2.53] for all-cause mortality, LRR, and DM, respectively) compared with patients with cervical SCC who received CCRT. CONCLUSION: Definitive CCRT in patients with cervical ADC resulted in lower overall survival, higher LRR, and higher DM rate compared with patients with cervical SCC. Funding Statement: Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, supports SzuYuan Wu’s work (Funding Number: 10908 and 10909). Declaration of Interests: The authors have no potential conflicts of interest to declare. Ethics Approval Statement: Our protocols were reviewed and approved by the Institutional Review Board of Taipei Medical University (TMU-JIRB No. 201712019).