IS THERE REALLY A DIFFERENCE IN SURVIVAL OF WOMEN WITH SQUAMOUS-CELL CARCINOMA, ADENOCARCINOMA, AND ADENOSQUAMOUS CELL-CARCINOMA OF THE CERVIX

Background. The authors' aim was to assess whether there is a differen ce in biologic behavior and survival in comparing adenocarcinoma (AdCA ), squamous cell carcinoma (SCC), and adenosquamous carcinoma (Ad/SC) of the cervix. Methods. Cancer registrars at 703 hospitals submitted a nonymous data on 11,157 patients with cervical cancer diagnosed and/or treated in 1984 and 1990 for a Patient Care Evaluation Study of the A merican College of Surgeons. Among these patients, 9351 (83.8%) had SC C; 1405 (12.6%), AdCA; and 401 (3.6%), Ad/SC cancers, There were no si gnificant changes in percentages of the different histologic types bet ween the study years 1984 and 1990, nor was the patient distribution d ifferent regarding age, race/ethnicity, and socioeconomic background f or each histologic group, Furthermore, the distribution of patients wh o had had a hysterectomy did not change between 1984 and 1990. Results . A larger percent of patients with SCC (63.8%) than those with Ad/SC (59.8%) or AdCA (50.2%) had tumors larger than 3 cm at greatest dimens ion, Early stage patients (IA, IB, IIA) often were treated by hysterec tomy alone (45.5%) or combined with radiation (21.1%), The remaining p atients (21.9%) received radiation alone. Of the patients with clinica l stage I disease, 7.6% of Ad/CA patients, 15.5% of Ad/SC patients and 12.6% of SCC patients had positive nodes. Although patients with SCC had higher survival rates for all four clinical stages (I-IV), the dif ferences were only significant for Stage II patients, Patients with cl inical stage IB SCC and AdCA treated by surgery alone were found to ha ve significantly better survival rates (93.1% and 94.6% at 5 years, re spectively) than women treated by either radiation alone or a combinat ion of surgery and radiation (P < 0.001, both histologic comparisons). For women with Ad/SC tumors, however, the 5-year survival rate was 87 .3% for those receiving combined treatment compared with those receivi ng surgery alone (69.2%) or radiation alone (79.2%), However, these su rvival curves were not significantly different (P = 0.496). One hundre d six patients with positive nodes were available for analysis. The 5- year survival rate of patients with SCC and positive nodes was 76.1%, Surprisingly, patients with Ad/SC and positive nodes had the highest 5 -year survival rate (85.7%), whereas, women with AdCA and positive nod es had a sharply reduced 5-year survival rate (33.3%), The curves were significantly different (P < 0.01). For patients with clinical stage I, the risk factors for age, tumor size, nodal status, histologic feat ures, and treatment were analyzed with Cox's multivariate regression. In this analysis, subset IB, greater tumor size, age 80 or older, and positive nodal status were each independently significant for poorer s urvival. Patients who were treated by surgery alone had a significantl y better survival than patients who had other types of treatment or no treatment. Histologic characteristics had no significant effect on su rvival. In the analysis of patients with pathologic stage I disease, t hose with SCC had significantly poorer survival and those with Ad/SC h ad significantly better survival than patients with Ad/CA. Positive no des had no significant independent effect on survival, Ire another ana lysis, tissue type was not found to be an important factor in recurren ce time. Conclusions: 1. Ad/CA and Ad/SC tumors were found to represen t 12.6% and 3.6%, respectively, of a large series (N = 11,157) of cerv ical cancers diagnosed in 1984 and 1990 and reported to the Commission on Cancer of the American College of Surgeons. 2. Two thirds of women with early clinical stage disease (IA, IB, IIA) had hysterectomy as a ll or part of their primary therapy. 3. No significant differences wer e found in 5-year survival among the three tissue types in any clinica l stage except American Joint Committee on Cancer stage II. 4. Surgery was found to be the treatment of choice for patients with Stage I SCC or Ad/CA, as judged by better survival rates, However, for patients w ith Ad/SC tumors, combined surgery and radiation seemed to result in h igher rates of cure. 5. Patients with Ad/CA with positive nodes had a significantly reduced 5-year survival rate (33.3%), compared with 76.1 % and 85.7% for patients with SCC and Ad/SC tumors, respectively. 6. I n a multivariate analysis of patients with clinical stage IB disease, tumor size, nodal metastases, and treatments other than surgery alone were independent prognostic factors, whereas, histologic type had no s ignificant effect on survival.