Optimal treatments for cervical adenocarcinoma

Abstract

To compare the effects of curative surgery and curative definitive concurrent chemoradiotherapy (CCRT) on cervical adenocarcinoma (AC) by conducting a national cohort study with a large sample size, we enrolled women with cervical AC and categorized them into two groups according to treatment modality to compare treatment outcomes: group 1, comprising patients who received curative surgery, and group 2, comprising patients who received curative definitive CCRT. Data of 1,621 patients with cervical AC were extracted from the Taiwan Cancer Registry database. Univariate and multivariate Cox regression analysis results indicated that high American Society of Anesthesiologists scores, advanced American Joint Committee on Cancer (AJCC) clinical stage, and curative definitive CCRT were significant independent poor prognostic factors. The adjusted hazard ratio (aHR; 95% confidence interval [CI]) for overall mortality in early invasive clinical stages (IB-IIA) was 1.27 (0.77-2.69) in group 2 compared with group 1, whereas that for overall mortality at AJCC clinical stage IIB was 2.46 (1.34-4.53) in group 2 compared with group 1. The aHR (95% CI) for overall mortality at advanced clinical stages (III and IV) was 1.47 (1.09-1.97) in group 2 compared with group 1. Curative surgery improves survival in cervical AC at advanced clinical stages. Either curative surgery or definitive CCRT is an option in the early invasive clinical stages of cervical AC.

Keywords: CCRT; Cervical adenocarcinoma; stages; surgery; survival.

Figure 1

Cox proportional hazards model curves for overall survival of patients with cervical adenocarcinoma who underwent different curative treatments in all stages, as obtained using the inverse probability of treatment weighting-adjusted Kaplan-Meier method (adjusted for age, income, region of residence, Charlson comorbidity index score, and American Joint Committee on Cancer stage). (All patients had an American Society of Anesthesiologists physical status score of 1, indicaitng tolerance of curative surgery). Note: P value of the Cox model test for cumulative incidence of death in the two groups was 0.004.