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Adenosquamous histology predicts a poor outcome for patients with advanced-stage, but not early-stage, cervical carcinoma†‡

  1. John H. Farley M.D.1,§,*,
  2. Kimberly W. Hickey M.D.1,
  3. Jay W. Carlson D.O.2,
  4. G. Scott Rose M.D.2,
  5. Edward R. Kost M.D.3,
  6. Terry A. Harrison M.D.4

Article first published online: 17 APR 2003

DOI: 10.1002/cncr.11371

Issue

Cancer

Cancer

Volume 97, Issue 9, pages 2196–2202, 1 May 2003

Additional Information

How to Cite

Farley, J. H., Hickey, K. W., Carlson, J. W., Rose, G. S., Kost, E. R. and Harrison, T. A. (2003), Adenosquamous histology predicts a poor outcome for patients with advanced-stage, but not early-stage, cervical carcinoma. Cancer, 97: 2196–2202. doi: 10.1002/cncr.11371

Author Information

  1. 1

    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tripler Army Medical Center, Honolulu, Hawaii

  2. 2

    Department of Gynecologic Oncology, Walter Reed Army Medical Center, Washington, DC

  3. 3

    Department of Gynecologic Oncology, Brooke Army Medical Center, San Antonio, Texas

  4. 4

    Department of Gynecologic Oncology, Naval Medical Center, San Diego, California

  1. §

    Fax: (808) 433-1552

*Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tripler Army Medical Center, 1 Jarrett White Road TAMC, Honolulu, HI 96859-5000

  1. †

    This article is a US Government work and, as such, is in the public domain in the United States of America.

  2. ‡

    The views expressed herein are those of the authors and do not reflect the official policy or opinion of the Department of Defense, the United States Army, or the United States Navy.

Publication History

  1. Issue published online: 17 APR 2003
  2. Article first published online: 17 APR 2003
  3. Manuscript Accepted: 21 JAN 2003
  4. Manuscript Revised: 30 DEC 2002
  5. Manuscript Received: 4 NOV 2002

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Keywords:

  • adenosquamous;
  • cervix;
  • carcinoma;
  • survival

Adenosquamous histology predicts poor outcome for patients with advanced-stage cervical carcinoma but not for patients with early-stage disease.

Abstract

BACKGROUND

The objective of this study was to compare survival between patients with adenocarcinoma and patients with adenosquamous carcinoma of the cervix.

METHODS

Patients who were diagnosed with invasive cervical carcinoma from 1988 to 1999 were identified from the Automated Central Tumor Registry for the United States Military Health Care System. Clinical data, including race, age at diagnosis, histology, tumor grade, disease stage, lymph node status, treatment modality, and survival, were collected. Survival analysis was performed with Kaplan–Meier survival curves and compared using the log-rank test.

RESULTS

A total of 273 women were identified, 185 women with a histologic diagnosis of adenocarcinoma (AC) and 88 women with a diagnosis of adenosquamous carcinoma (ASC). Among the women with ASC, only 5% had Grade 1 tumors, and 66% had Grade 3 tumors. By comparison, among the women with AC, 37% had Grade 1 tumors, and 26% had Grade 3 tumors (P < 0.001). There was no difference in the incidence of positive lymph nodes or in the number of patients who underwent radical hysterectomy as primary treatment between patients with ASC and patients with AC. More patients with ASC received radiation therapy (51% vs. 28%) or chemotherapy (29% vs. 12%) as treatment (P < 0.001). Patients who had tumors with ASC histology had a significantly decreased 5-year survival rate compared with patients who had tumors with AC histology (65% vs. 83%; P < 0.002). When patients with early-stage cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] Stage I) were examined separately, there was no statistically significant difference in the 5-year survival rate (AC, 89%; ASC, 86%; P = 0.644). However, when patients with advanced-stage disease (FIGO Stages II–IV) were analyzed, ASC was associated with a significant decrease in median and overall survival (P = 0.01). When the results were analyzed by grade, patients who had tumors with ASC histology had a shorter survival compared with patients who had AC histology of any grade; however, this was a significant difference only for patients with Grade 1 tumors: The 5-year survival rate for patients with Grade 1 AC was 93%, compared with 50% for patients with Grade 1 ASC (P < 0.01).

CONCLUSIONS

ASC histology appears to be an independent predictor of poor outcome in women with cervical carcinoma compared with their counterparts who have pure AC. The significant decrease in survival was observed only in patients with advanced-stage cervical carcinoma. This decreased survival may be related mainly to the grade of ASC. Cancer 2003;97:2196–202. Published 2003 American Cancer Society.

DOI 10.1002/cncr.11371

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