The prognostic value of histologic subtype in node-positive early-stage cervical cancer after hysterectomy and adjuvant radiotherapy

Abstract Background To assess the survival outcomes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–IIA adenocarcinoma (AC) or squamous cell carcinoma (SCC) of the uterine cervix after hysterectomy and adjuvant radiotherapy (RT). Methods Patients with a primary diagnosis of FIGO stage I–IIA AC or SCC of the uterine cervix after hysterectomy and adjuvant RT between 1988 and 2012 were included using data from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression analyses were used to analyze the effect of histologic subtype on cause-specific survival (CSS) and overall survival (OS). Results We included 1171 patients: 919 with cervical SCC and 252 with cervical AC. In multivariate analysis, cervical AC was an independent adverse prognostic factor for survival. Patients with cervical AC had worse CSS ( p  = 0.001) and OS ( p  = 0.001) compared to patients with cervical SCC. In the subgroup analysis, patients with cervical SCC in the era of concurrent chemoradiotherapy (CCRT) (2000–2012) had better CSS ( p  = 0.006) and OS ( p  = 0.004) compared with the era of RT. However, there was no significant difference in CSS ( p  = 0.079) and OS ( p  = 0.053) between the eras of RT (1988–1999) and CCRT for patients with cervical AC. Conclusions Survival of cervical AC is significantly worse than that of cervical SCC. As CCRT usage increases, the survival benefit is derived only in cervical SCC, but not in cervical AC.