Are adenocarcinomas and adenosquamous carcinomas different from squamous carcinomas in stage IB and II cervical cancer patients undergoing primary radical surgery?

The aim of this study was to define clinicopathologic features and to inves tigate prognostic factors in early-stage cervical adenocarcinomas and adeno squamous carcinomas in patients undergoing primary radical surgery. One hun dred thirty-four patients with stage IB or II cervical adenocarcinoma or ad enosquamous carcinomas treated at a single institution were reviewed and co mpared to squamous carcinomas (N = 757) treated in the same period. Among a deno-adenosquamous carcinomas, stage II disease, parametrial extension, and deep cervical stromal invasion (>2/3) were associated with increased risk of pelvic lymph node metastases, while only clinical stage II, DNA index >1 .3 (by flow cytometry), and pelvic node metastases were significantly assoc iated with decreased survival by multivariate analyses. The five-year recur rence-free and overall survival rates of patients with adeno-adenosquamous vs squamous carcinoma were 72.2% vs 81.2% (P = 0.0109), and 74.1% vs 82.8% (P = 0.0136), respectively by Mantel-Cox test. After controlling confoundin g factors, histologic type (adeno-adenosquamous vs squamous) was confirmed as an independent prognostic factor for recurrence-free survival [relative risk (RR): 1.2792; 95% confidence interval (CI): 1.0628-1.5399, P = 0.0092) and overall survival (RR: 1.2594, 95% CI: 1.0467-1.5155, P = 0.0146) in th e whole series (N = 891). Although pattern of relapse by histologic type wa s not significantly different, patients with recurrent adeno-adenosquamous carcinoma did significantly worse than those with recurrent squamous carcin oma. In conclusion, the prognosis of adeno-adenosquamous carcinoma of the c ervix is slightly worse than squamous tumors. Since salvage of recurrent ad eno-adenosquamous carcinoma after primary radical surgery is generally inef fective using conventional treatment, innovative strategies are necessary f or the high-risk group after primary surgery and all recurrent adeno-adenos quamous carcinomas regardless of size or site.