Abstract 168: The significance of squamous vs. adenocarcinoma subtypes in early-stage cervical carcinoma.
Authors: Winer Ira , Alvarado-Cabrero Isabel , Seward Shelly , Valencia-Cedillo Raquel , Munkarah Adnan , Ali-Fehmi Rouba 
Published: August 2014

Objective: Historically, cervical adenocarcinomas have been viewed as more aggressive than squamous cell carcinoma (SCC) in multiple small cohorts. We analyzed the largest Latino cohort of early stage cancer to determine the impact of histologic type.

Methods: Retrospective analysis of patients with SCC and adenocarcinoma stages IA1-IB2 at the Mexican Oncology Hospital from 2000-2010 was performed for: age, stage, tumor size, lymphovascular invasion (LVI), invasion depth, lymph node status, recurrence and survival. Pathologic review proceeded inclusion. 64 patients with SCC were recruited between 2000-2003. 101 patients with adenocarcinoma were recruited between 2000-2010. Categorical variables were analyzed by chi square and continuous variables using one-way ANOVA analysis.

Results: Results are summarized in Table 1. Adenocarcinomas tended to be higher grade (p= 0.01), while SCC's were larger with deeper invasion (p&lt;0.001). Stage, LVI and lymph node status were not significantly different. Recurrence rate (RR) was 5% (5/101) in adenocarcinomas and 8% (5/64) in SCC's. 5 year survival (OS) was equivalent (98.2% and 95.2% for adenocarcinoma and SCC respectively, p=0.369). In adenocarcinomas, in the absence of LVI, no patients (0/75) had positive lymph nodes. Adenocarcinomas received more adjuvant radiation therapy (RT) when compared to SCC's (71.3% vs. 37.5%); given high survival and low recurrence we were unable to evaluate RT's effect on OS and RR.

Conclusion: Patients with early stage adenocarcinomas have smaller, higher grade tumors than patients with SCC with no difference in LVI, lymph node involvement, recurrence rate or survival. . A potential confounding factor was higher rate of adjuvant RT in adenocarcinoma vs. SCC patients. Overall, these findings suggest the need for more aggressive therapy in the treatment of early stage cervical adenocarcinoma should be investigated further, potentially reducing morbidity in this cohort of patients.

  Adenocarcinoma (n = 101) Squamous (n = 64) p-value Age (Median) 51 (35–80) 51 (22–86) NS Stage NS IA1 3 (3%) 1 (1.6%) IA2 1 (1%) 0 (0%) IB1 96 (95%) 54 (84.4%) IB2 1 (1%) 9 (14%) Lymph Node NS Positive 16 (15.8%) 13 (20.3%) Negative 85 (84.2%) 51 (79.7%) Grade p = 0.01 1 19 (18.8%) 14 (21.9%) 2 50 (49.5%) 45 (70.3%) 3 32 (31.7%) 5 (7.8%) LVI NS Positive 26 (25.7%) 21 (32.8%) Negative 75 (74.3%) 43 (67.2%) Missing 0 (0%) 0 (0%) Tumor Diameter(Mean cm) 1.99 (1.8–2.4) 2.77 (2.5–3.03) p &lt; 0.0001 Invasion Depth (Mean cm) 0.78 (0.7–0.86) 1.6 (1.3–1.6) p &lt; 0.0001 Treatment p = 0.001 Surgery 29 (28.7%) 34 (53%) Surgery+RT 72 (71.3%) 30 (47%) Recurrence NS Yes 5 (5.0%) 5 (7.9%) No 76 (75.2%) 56 (87.5%) Missing 20 (19.8%) 3 (4.6%) Survival NS Alive 78 (77.3%) 56 (88.9%) Alive with Disease 3 (3.0%) 4 (6.3%) Dead 1 (0.9%) 3 (4.8%) Missing 19 (18.8%) 0 (%) Follow-up (Median yrs) 4 (1–8) 4 (1–8) NS

Citation Format: Ira Winer, Isabel Alvarado-Cabrero, Shelly Seward, Raquel Valencia-Cedillo, Adnan Munkarah, Rouba Ali-Fehmi. The significance of squamous vs. adenocarcinoma subtypes in early-stage cervical carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 168. doi:10.1158/1538-7445.AM2013-168