Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix - A population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix

BACKGROUND. The incidence of adenocarcinoma of the uterine cervix is increa sing. For better, prognostic information, the authors studied all nonsquamo us cell car cinomas (non-SCCs) in the Norwegian population over a total of 15 years. METHODS. All non-SCCs from three 5-year periods (1966-1970, 1976-1980, and 1986-1990) were reviewed and classified according to the World Health Organ ization classification system, and histopathologic and clinical parameters were registered. Tissue blocks were available from all patients. RESULTS. Of 505 patients, 417 had tumors classified as adenocarcinoma, and 88 had tumors classified as other non-SCC. The mean ages were 53 years and 52 years for patients with adenocarcinoma and non-SCC, respectively. Sixty- two percent of the staged patients had clinical Stage I disease according t o the classification system of the International Federation of Gynecology a nd Obstetrics (FIGO). In univariate analyses, histology, architectural and nuclear grade, extension to the vagina or corpus uteri, tumor length (> 20 mm) or tumor volume (> 3000 mm(3)), infiltration depth (in thirds of the ce rvical wall), thickness of the remaining wall (< 3 mm), vascular invasion, lymph node metastases, treatment, and patient age were significant variable s in patients with FIGO Stage I disease. Variables with no significance in patients with Stage I disease were number of mitoses, state of resection ma rgins, infiltration to ectocervix, tumor thickness, lymphoid reaction, earl ier or concomitant cervical intraepithelial neoplasia, stump carcinoma, DNA ploidy or DNA index, or time period. Multivariate analyses of patients wit h FIGO Stage I disease identified small cell carcinoma, corpus infiltration , vascular invasion, and positive lymph nodes as independent prognostic fac tors. CONCLUSIONS. Small cell carcinoma was the only histologic subgroup of indep endent importance for prognosis in patients with noti-SCC of the uterine ce rvix. No significant difference between major subtypes of adenocarcinoma fa vored a simplified classification. Extension to the corpus in patients with early-stage disease was of independent significance and should be acknowle dged in planning treatment. (C) 2001 American Cancer Society.