Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;118(2):162-170.
doi: 10.1038/bjc.2017.400. Epub 2017 Nov 28.

Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

Leigh G Seamon  1 , James J Java  2 , Bradley J Monk  3 , Richard T Penson  4 , Jubilee Brown  5 , Robert S Mannel  6 , Anna Oaknin  7 , Mario M Leitao  8 , Eric L Eisenhauer  9 , Harry J Long  10 , Shu Y Liao  11 , Krishnansu S Tewari  11
Affiliations

Impact of tumour histology on survival in advanced cervical carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

Leigh G Seamon et al. Br J Cancer. 2018 Jan.

Abstract

Background: Based primarily on studies concerning early-stage tumours (treated surgically), and locally advanced disease (treated with chemoradiation), the prognosis for women with adenocarcinoma (AC) or adenosquamous (AS) carcinoma has been reported to be poorer than those with squamous cell carcinoma (SCCA) of the cervix. It is unclear whether differences in prognosis also persist in the setting of recurrent or metastatic disease treated using chemotherapy doublets with or without bevacizumab.

Methods: Cases were pooled from three Gynaecologic Oncology Group randomised phase III trials of chemotherapy doublets. Pearson's test was used to evaluate response rate (RR) of AC/AS vs SCCA, Kaplan-Meier method to estimate progression-free survival (PFS) and overall survival (OS), and Cox proportional hazards model to estimate the impact of histology on PFS and OS.

Results: Of 781 evaluable patients, 77% (N=599) had SCCA and 23% (N=182) AC/AS. There were no significant differences in RRs between histologic subgroups. The adjusted hazard ratio (HR) for death for SCCA vs AC/AS was 1.13 (95% CI 0.93, 1.38 P=0.23). When comparing SC/AS (N=661, 85%) to AC alone (N=120, 15%), the adjusted HR for death was 1.23 (95% CI 0.97, 1.57, P=0.09).

Conclusions: AC/AS and SCCA have similar survival in recurrent or metastatic cervical carcinoma when treated with chemotherapy doublets.

PubMed Disclaimer

Conflict of interest statement

All the authors cite no relevant conflicts of interest related to this manuscript, except as noted below: Dr(s) Tewari (study chair/principal investigator for GOG 240), Penson (quality of life chair for GOG 240), Oaknin (Spain chair through GEICO for GOG 240), and Monk (senior author of GOG 240 and chair of the Cervix Cancer Committee of the NRG Oncology Cooperative Group and co-chair of the Gynaecologic Cancer Intergroup) were members of the scientific steering committee that conducted GOG 240. To participate in the regulatory discussions through which bevacizumab could potentially be approved for women struggling with advanced cervical cancer, these authors as well as author Eisenhauer participated on 1-2 advisory boards held by Roche/Genentech. Monk, Penson, and Tewari subsequently joined the Roche/Genentech speaker’s bureau to help review appropriate patient selection and management of bevacizumab-related adverse events with the oncology community. The institutions where Monk, Oaknin, and Tewari practice have contracted research grants with Roche/Genentech to conduct trials evaluating the anti-PD-L1 agent, atezolizumab. Roche/Genentech contracted research with institution: Monk, Oaknin, Tewari; Roche/Genentech Advisory Boards participation: Monk, Penson, Eisehauer, Tewari; Roche/Genentech Speaker’s Bureau: Monk, Penson, Tewari.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of overall survival. (A) Primary objective (SCCA vs AC+AS carcinoma) and (B) secondary objective (SCCA+AS vs AC).
Figure 2
Figure 2
Squamous cell carcinoma vs AC vs AS of the uterine cervix: different diseases? (A) Histologic appearance of SCCA (left), AC (centre), and AS (right). (B) Human papillomavirus 16 genome (left) and HPV 18 genome (right). (C) Proposed molecular cascade through which tumour hypoxia and HPV oncogenes E6 and E7 drive angiogenesis.
See this image and copyright information in PMC

References

    1. Berrington de Gonzalez A, Sweetland S, Green J (2004) Comparison of risk factors for squamous cell and adenocarcinomas of the cervix: a meta-analysis. Br J Cancer 90(9): 1787–1791. - PMC - PubMed
    1. Burger RA, Brady MF, Bookman MA, Fleming GF, Monk BJ, Huang H, Mannel RS, Homesley HD, Fowler J, Greer BE, Boente M, Birrer MJ, Liang SX (2011) Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 365(26): 2473–2483. - PubMed
    1. Cox DR (1972) Regression models and life-tables. J R Stat Soc Ser B 34(2): 187–220.
    1. Eskander RN, Tewari KS (2014) Targeting angiogenesis in advanced cervical cancer. Ther Adv Med Oncol 6(6): 280–292. - PMC - PubMed
    1. Fujiwara K, Monk B, Devouassoux-Shisheboran M (2014) Adenocarcinoma of the uterine cervix: Why is it different? Curr Oncol Rep 16(12): 416. - PubMed

MeSH terms