PROGNOSTIC FACTORS OF PRIMARY ADENOCARCINOMA OF THE UTERINE CERVIX

Objective. To determine which clinicopathological factors influence th e prognosis of cervical adenocarcinoma. Methods. Three hundred and two cases of primary adenocarcinoma of the uterine cervix, treated betwee n 1977 and 1994, were studied retrospectively. Clinical data and patho logical findings with respect to primary therapy were reviewed and eva luated. Results. The 5-year survival rates for stages I, II, and III/I V were 75.9, 62.9, and 25.1%, respectively. International Federation o f Gynecology and Obstetrics stage (P < 0.0001), cell type (P = 0.0176) , tumor grade (P = 0.023), lymph node status (P = 0.018), and bulky tu mor (P = 0.007) were found to be independent factors using the stepwis e Cox proportional hazards model. Old age (P = 0.0581), presence of hy pertension (P = 0.46), diabetes mellitus (P = 0.18), obesity (P = 0.15 ), and oral contraceptive use (P = 0.42) were not found to adversely i nfluence survival rates for cervical adenocarcinoma after adjusting fo r other covariates. Adenosquamous adenocarcinoma had a better prognosi s than endocervical columnar cell adenocarcinoma in stages I and II (P = 0.0235). Also, in cervical adenocarcinoma's early stages, multivari ate modeling revealed that chances of survival were significantly bett er for patients treated by radical surgery than for patients treated b y radiation therapy (P < 0.001). Conclusions. Survival rates for cervi cal adenocarcinoma were significantly influenced by stage, histologic subtype, tumor grade, the presence of a positive lymph node, and tumor size. Although a randomized prospective study is needed, our data imp ly that radical surgery may be considered a better primary modality of treatment than radiation therapy for the early stages of cervical ade nocarcinoma. Further, the presence of hypertension, diabetes mellitus, or obesity map not adversely influence survival rates. (C) 1998 Acade mic Press.