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Xiao ML, Fu L, Ma FH, Li YA, Zhang GF, Qiang JW. Comparison of MRI features among squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma, usual-type endocervical adenocarcinoma and gastric adenocarcinoma of cervix. Magn Reson Imaging 2024; 112:10-17. [PMID: 38848968 DOI: 10.1016/j.mri.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To compare and explore the characteristics of squamous cell carcinoma (SCC), adenocarcinoma (AC) and adenosquamous carcinoma (ASC), usual-type endocervical adenocarcinoma (UEA) and gastric adenocarcinoma (GAC) of cervix. MATERIALS AND METHODS A total of 728 cervical cancers (254 cases of AC, 252 cases of ASC, and 222 cases of SCC) confirmed by histopathology were retrospectively reviewed. Among AC, 119 UEA and 47 GAC were included. Clinical baseline data and tumor morphological features on MRI (including tumor location, shape, diameter and volume, margin, growth pattern, presence of fluid component or cyst, heterogenous and peritumoral enhancement) of all cases were collected and analyzed. The signal intensity (SI) of tumor and gluteus maximus muscle were measured and their ratios (SIR) were calculated based on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and contrast-enhanced T1WI at arterial and delay phases (A/DCE-T1WI). These clinical and MRI features were compared between SCC, AC and ASC, UEA and GAC, and the specific ones of each subtype were identified. RESULTS There was a significant difference in SCC-Ag, CA-199, CEA, ADC value, SIR-DWI, presence of intratumor cyst and peritumoral enhancement between AC and ASC; in patient age, menopausal status, International Federation of Gynecology and Obstetrics (FIGO) stage, SCC-Ag, CA-125, CA-199, CEA, tumor shape, growth pattern, margin, presence of intratumor fluid component and cyst, tumor diameter and volume, ADC value, SIR-T1WI, SIR-T2WI, and SIR-DWI between SCC and AC, as well as SCC and ASC. Also, there was a significant difference in deep stromal invasion (DSI), peritumoral and heterogenous enhancement between SCC and AC, and in SIR-ACE-T1WI between SCC and ASC. There was a significant difference in reproductive history, menopausal status, FIGO stage, CA-199, DSI, lymph node metastasis (LNM), parametrial invasion (PMI), tumor location, shape, margin, growth pattern, presence of fluid component and cyst, tumor diameter and volume, SIR-T1WI, SIR-DWI, and heterogenous enhancement between GAC and UEA. CONCLUSION The clinical and MRI features with significant differences among SCC, AC and ASC, and between UEA and GAC, can help to identify each subtype of cervical cancer.
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Affiliation(s)
- Mei Ling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai 201508, China; Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Le Fu
- Department of radiology, Shanghai First Maternity and Infant Hospital, Tongji University, 536 ChangleRoad, Shanghai 200092, China
| | - Feng Hua Ma
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai 200090, China
| | - Yong Ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai 201508, China
| | - Guo Fu Zhang
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai 200090, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai 201508, China.
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Kim Y, Kim SI, Kim H, Lee M, Kim HS, Kim K, Chung HH, No JH, Kim YB, Kim JW, Park NH, Song YS, Lee C, Suh DH. Open versus minimally invasive radical hysterectomy for early cervical cancer: A two-center retrospective cohort study with pathologic review of usual-type adenocarcinoma and adenosquamous carcinoma. Gynecol Oncol 2022; 167:28-36. [PMID: 35970602 DOI: 10.1016/j.ygyno.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare survival outcomes of minimally invasive surgery (MIS) and open surgery for radical hysterectomy (RH) in early cervical cancer patients with histologic subtypes of usual-type adenocarcinoma and adenosquamous carcinoma. METHODS From two centers' cervical cancer cohorts, patients with 2009 FIGO stage IB1-IB2 who underwent RH between 2007 and 2020 were retrospectively identified. Patients with usual-type adenocarcinoma and adenosquamous carcinoma were included in the analysis after pathologic review according to the updated World Health Organization Classification of Tumors. Clinicopathologic characteristics and survival outcomes were compared in terms of open surgery or MIS. RESULTS This study included 161 patients. No significant differences were noted in overall survival (OS; P = 0.241) and disease-free survival (DFS; P = 0.156) between patients with usual-type adenocarcinoma (n = 136) and those with adenosquamous carcinoma (n = 25). MIS RH group (n = 99) had a significantly smaller tumor size (P < 0.001), lesser pathologic parametrial invasion (P = 0.001), and lesser lymph node metastasis (P < 0.001) than open RH group (n = 62). MIS and open RH groups showed similar OS (P = 0.201) and 3-year DFS rate (87.9% vs. 75.1%; P = 0.184). In multivariate analysis, worse DFS was not associated with MIS (P = 0.589) but was associated with pathologic parametrial invasion (adjusted HR, 3.41; 95% CI, 1.25-9.29; P = 0.016). Consistent results were observed among patients with usual-type adenocarcinoma; MIS was not associated with worse DFS. CONCLUSIONS Comparable survival outcomes were found for MIS and open RH in early-stage cervical usual-type adenocarcinoma and adenosquamous carcinoma. Although MIS RH was not a poor prognostic factor, pathologic parametrial invasion was significantly associated with worse DFS in cervical usual-type adenocarcinoma and adenosquamous carcinoma.
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Affiliation(s)
- Yeorae Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hyojin Kim
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Pathology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Cheol Lee
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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Zhou Y, Wang W, Hu K, Zhang F. Comparison of Outcomes and Prognostic Factors Between Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma Patients After Radical Surgery and Postoperative Adjuvant Radiotherapy. Cancer Manag Res 2021; 13:7597-7605. [PMID: 34675656 PMCID: PMC8500504 DOI: 10.2147/cmar.s329614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose No consensus has been reached regarding the survival difference between cervical adenocarcinoma (ADC) and adenosquamous carcinoma (ASC) patients. The purpose of this study was to compare survival outcomes and prognostic factors between early-stage ADC and ASC patients. Patients and Methods We retrospectively reviewed stage IB-IIA patients with ADC and ASC who underwent radical hysterectomy and postoperative radiotherapy between June 2012 and December 2017. Results A total of 125 patients were enrolled in our study (97 with ADC and 28 with ASC). The median follow-up period was 53.4 months. Compared with ASC patients, patients with ADC tended to have a higher proportion of positive pelvic lymph nodes (7.1% and 26.8%, respectively; p = 0.028). The most common site of distant metastasis was the lung, followed by the intestine and colon. The 5-year overall survival (OS), disease-free survival (DFS), pelvic control, and distant control rates for ADC and ASC patients were 83.6% and 92.0% (p = 0.349), 77.5% and 87.7% (p = 0.279), 81.8% and 96.2% (p = 0.121), and 88.3% and 87.7% (p = 0.948), respectively. Parametrial invasion was a prognostic factor for OS. Lymphovascular space involvement was a prognostic factor for DFS. Conclusion ADC patients were more likely to have positive pelvic lymph nodes than those with ASC. There was no significant difference in survival outcomes between patients with ADC and ASC.
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Affiliation(s)
- Yuncan Zhou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Mizuno T, Kojima Y, Yonemori K, Yoshida H, Sugiura Y, Ohtake Y, Okuma HS, Nishikawa T, Tanioka M, Sudo K, Shimomura A, Noguchi E, Kato T, Shimoi T, Uno M, Ishikawa M, Fujiwara Y, Ohe Y, Tamura K. HER3 protein expression as a risk factor for post-operative recurrence in patients with early-stage adenocarcinoma and adenosquamous carcinoma of the cervix. Oncol Lett 2020; 20:38. [PMID: 32802162 PMCID: PMC7412725 DOI: 10.3892/ol.2020.11899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/19/2020] [Indexed: 02/03/2023] Open
Abstract
Patients with cervical adenocarcinoma (AC) and adenosquamous carcinoma (ASC) have a poorer prognosis than those with squamous cell carcinoma (SCC). Erb-b2 receptor tyrosine kinase 3 (HER3) is a member of the epidermal growth factor receptor family and its expression is associated with unfavorable prognosis in several cancer types, including SCC of the cervix. As there is limited information on the prognostic value of HER3 for AC and ASC of the cervix, the present study aimed to evaluate the expression of HER3 and its impact on post-operative recurrence in patients with AC and ASC of the cervix. This retrospective study included 39 patients with early-stage AC and ASC who underwent primary surgery between January 1997 and December 2017. Immunohistochemical staining for HER3 was performed on formalin-fixed paraffin-embedded surgical specimens. The possible influence of HER3 expression on disease-free survival (DFS) was studied by using multivariate Cox regression with adjustment for established risk factors of post-operative recurrence. High expression of HER3 (HER3-high) was detected in 85.1% of cases of AC (23/27) and in 58.3% of cases of ASC (7/12). The median follow-up duration was 63.1 months and Kaplan-Meier analysis indicated that the 5-year DFS rates of patients with AC and ASC of the cervix were 56.7% in patients with HER3-high and 77.8% in patients with HER3-low (log rank, P=0.20). On multivariate analysis, HER3-high [hazard ratio (HR)=6.32, 95% CI: 1.10–36.26, P=0.039), pelvic lymph node metastasis (HR=7.61, 95% CI: 2.07–28.00, P=0.002) and vascular invasion (HR=4.28, 95% CI: 1.12–16.31, P=0.033) were indicated to be independent predictors of DFS. To date, the present study is the most comprehensive analysis to evaluate the expression of HER3 in patients with early-stage AC and ASC of the cervix. The results suggested that HER3 overexpression may be an independent risk factor for post-operative recurrence. However, these results and the prognostic value of HER3 should be confirmed in a larger sample.
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Affiliation(s)
- Takaaki Mizuno
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.,Cancer Medicine, Jikei University Graduate School of Medicine, Tokyo 105-8461, Japan
| | - Yuki Kojima
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Kan Yonemori
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hiroshi Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yukiko Sugiura
- Department of Gynecology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yohei Ohtake
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hitomi S Okuma
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tadaaki Nishikawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Maki Tanioka
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Kazuki Sudo
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Emi Noguchi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tatsunori Shimoi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yasuhiro Fujiwara
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yuichiro Ohe
- Cancer Medicine, Jikei University Graduate School of Medicine, Tokyo 105-8461, Japan
| | - Kenji Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
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Zhang X, Lv Z, Xu X, Yin Z, Lou H. Comparison of adenocarcinoma and adenosquamous carcinoma prognoses in Chinese patients with FIGO stage IB-IIA cervical cancer following radical surgery. BMC Cancer 2020; 20:664. [PMID: 32678039 PMCID: PMC7367379 DOI: 10.1186/s12885-020-07148-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To compare adenocarcinoma (AC) and adenosquamous carcinoma (ASC) prognoses in patients with FIGO stage IB-IIA cervical cancer who underwent radical hysterectomy. METHODS We performed a retrospective analysis of 240 patients with AC and 130 patients with ASC. Kaplan-Meier curves, Cox regression models, and log-rank tests were used for statistical analysis. RESULTS Patients with ASC had higher frequencies of lymphovascular space invasion (LVSI) and serum squamous cell carcinoma antigen (SCC-Ag) > 5 ng/ml (p = 0.049 and p = 0.013, respectively); moreover, they were much older (P = 0.029) than patients with AC. There were no clinically significant differences in overall survival (OS) between the groups. When stratified into three risk groups based on clinicopathological features, survival outcomes did not differ between patients with AC and those with ASC in any risk group. Multivariate analysis showed that lymph node metastasis (LNM) was an independent risk factor for recurrence-free survival (RFS) and OS in patients with AC and in patients with ASC. Carcinoembryonic antigen (CEA) > 5 ng/ml and SCC-Ag > 5 ng/ml were independent predictors of RFS and OS in patients with AC. In addition, among those stratified as intermediate-risk, patients with ASC who received concurrent chemoradiotherapy (CCRT) had significantly better RFS and OS (P = 0.036 and P = 0.047, respectively). CONCLUSIONS We did not find evidence to suggest that AC and ASC subtypes of cervical cancer were associated with different survival outcomes. CCRT is beneficial for survival in intermediate-risk patients with ASC, but not in those with AC. Serum tumour markers can assist in evaluating prognosis and in providing additional information for patient-tailored therapy for cervical AC.
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Affiliation(s)
- Xiaojing Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute ofCancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, P. R. China
| | - Zunfu Lv
- Department of Agriculture and Food Science, Zhejiang A&F University, Lin'an, 311300, P. R. China
| | - Xiaoxian Xu
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute ofCancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, P. R. China
| | - Zhuomin Yin
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute ofCancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, P. R. China
| | - Hanmei Lou
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute ofCancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, P. R. China.
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Surgical Treatment of Early-Stage Cervical Cancer: A Multi-Institution Experience in 2124 Cases in The Netherlands Over a 30-Year Period. Int J Gynecol Cancer 2019; 28:757-763. [PMID: 29595758 DOI: 10.1097/igc.0000000000001228] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to describe the pattern of recurrence and survival related to prognostic variables, including type of surgery as a clinical variable, in patients surgically treated for early cervix cancer. METHODS Records of 2124 patients who underwent a radical hysterectomy for International Federation of Gynaecology and Obstetrics stage I/IIA cervical cancer between 1982 and 2011 were reviewed. Clinical-pathologic prognostic variables, also including extent of parametrectomy, were identified and used in a multivariable Cox proportional hazard model to explore associations between disease-free survival (DFS) and prognostic variables. RESULTS The 5-year DFS for the total group was 86%. Large tumor diameter, nonsquamous histology, lymph node metastases, parametrial involvement, lymph vascular space invasion, deep stromal invasion, and less radical surgery were independent poor prognostic variables for survival. Disease-free survival was independently associated with the type of radical hysterectomy with pelvic lymphadenectomy in favor of more radical parametrectomy (hazard ratio, 2.0; 95% confidence interval, 1.6-2.5). This difference was not found in tumors with a diameter of at least 20 mm. CONCLUSIONS This study confirms that variables such as large tumor diameter, nonsquamous histology, lymph vascular space invasion, deep stromal invasion, positive lymph nodes, and parametrial infiltration are poor prognostic variables in early cervix cancer treated by surgery. The extent of parametrectomy had no influence on survival in tumors of 20 mm or less. For larger tumors, a more radical hysterectomy might be associated with better DFS. Taking into account the possible bias in this study as a result of its retrospective design, ideally a prospective cohort study with clear definition of radicality is necessary to answer this important clinical question.
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Li X, Li J, Jiang Z, Xia L, Ju X, Chen X, Wu X. Oncological results and recurrent risk factors following abdominal radical trachelectomy: an updated series of 333 patients. BJOG 2019; 126:1169-1174. [PMID: 30663205 DOI: 10.1111/1471-0528.15621] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To update the oncological results and identify recurrent risk factors in young patients with early stage cervical cancers following abdominal radical trachelectomy (ART). DESIGN Retrospective study. SETTING A university-based cancer hospital. POPULATION Three hundred and thirty-three patients. METHODS We conducted a retrospective analysis from a prospectively maintained database of patients undergoing ART from April 2004 to December 2017. MAIN OUTCOME MEASURES Survival rate, clinicopathological factors related to recurrences. RESULTS Two hundred and seventy-one patients had squamous carcinomas (SCC), 51 had pure adenocarcinomas (AC), and 11 had adenosquamous carcinomas (AS). One hundred thirty-two women (39.6%) had tumours ≥2 cm. With a median follow up of 56 months (range, 6-169), 11 patients (3.3%) had recurrence, and five patients (1.5%) died. The cumulative 5-year recurrence-free survival and overall survival rates were 96.3 and 98.6%, respectively. The recurrence rate in women with tumours ≥2 cm was comparable to that in patients with tumours <2 cm (5.3 versus 2.0%, respectively, P = NS). However, the recurrence rate was significantly higher in patients with AS histology than those with AC and SCC histology (18.2, 3.9, and 2.6%, respectively, P < 0.05). All of the recurrent patients with AS histology had tumours ≥2 cm. Multivariate analysis showed that the only independent risk factor for recurrence was histology type. CONCLUSIONS This updated series showed a favourable survival rate following ART. These results further supported that ART was a safe option for well-selected patients with stage IB1 cervical cancers ≥2 cm. However, if patients with tumours ≥2 cm have AS histology, they should be advised with great caution when contemplating ART. TWEETABLE ABSTRACT Abdominal radical trachelectomy could be a safe, fertility-sparing option for strictly selected patients with stage IA1-IB1 cervical cancers ≤4 cm.
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Affiliation(s)
- X Li
- Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - J Li
- Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Z Jiang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Centre, Shanghai, China
| | - L Xia
- Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - X Ju
- Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - X Chen
- Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - X Wu
- Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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8
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Nicolás-Párraga S, Alemany L, de Sanjosé S, Bosch FX, Bravo IG. Differential HPV16 variant distribution in squamous cell carcinoma, adenocarcinoma and adenosquamous cell carcinoma. Int J Cancer 2017; 140:2092-2100. [PMID: 28187495 DOI: 10.1002/ijc.30636] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/16/2016] [Accepted: 01/20/2017] [Indexed: 11/07/2022]
Abstract
Human Papillomavirus 16 (HPV16) causes 70% of invasive cervical cancers (ICC) worldwide. Interaction between HPV16 genetic diversity, host genetics and target tissue largely determine the chances to trigger carcinogenesis. We have analyzed the differential prevalence of viral variants in 233 HPV16-monoinfected squamous (SCC), glandular (ADC) and mixed (ADSC) ICCs from four continents, assessing the contribution of geographical origin and cancer histology. We have further quantified the contribution of viral variants and cancer histology to differences in age at tumor diagnosis. The model fitted to the data explained 97% of the total variance: the largest explanatory factors were differential abundance among HPV16 variants (78%) and their interaction with cancer histology (9.2%) and geography (10.1%). HPV16_A1-3 variants were more prevalent in SCC while HPV16_D variants were increased in glandular ICCs. We confirm further a non-random geographical structure of the viral variants distribution. ADCs were diagnosed at younger ages than SCCs, independently of the viral variant triggering carcinogenesis. HPV16 variants are differentially associated with histological ICCs types, and ADCs are systematically diagnosed in younger women. Our results have implications for the implementation of cervical cancer screening algorithms, to ensure proper early detection of elusive ADCs.
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Affiliation(s)
- S Nicolás-Párraga
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - L Alemany
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - S de Sanjosé
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - F X Bosch
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain
| | - I G Bravo
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,UMR MIVEGEC, National Center for Scientific Research (CNRS), Montpellier, France
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Chandeying N, Hanprasertpong J. The prognostic impact of histological type on clinical outcomes of early-stage cervical cancer patients whom have been treated with radical surgery. J OBSTET GYNAECOL 2017; 37:347-354. [PMID: 28141947 DOI: 10.1080/01443615.2016.1245279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to determine the prognostic impact of histological type among squamous cell carcinoma (SCC), adenocarcinoma (AC) and adenosquamous carcinoma (ASC) on the treatment outcome of early-stage cervical cancer patients after radical hysterectomy. The cohort comprised of 626 patients, diagnosed with stages IA2-IB1 cervical cancer between 1987 and 2013. Four hundred and one patients had SCC, 190 had AC and 35 had ASC. The 5-year disease-free survival (DFS) rates for AC, SCC and ASC were 89.3% (95%CI 83.2-93.2), 88.7% (95%CI 84.8-91.7) and 82.1% (95%CI 61.9-92.2), respectively (p = .594). In multivariate analyses, only older age and deep stromal invasion were statistically significantly associated with DFS, whereas histologic cell type was not (p = .524). Subgroup analysis showed that in the intermediate-high-risk groups, the SCC group had a significantly longer DFS, compared with the AC group or the ASC group (p = .001) while there was no DFS difference in the low-risk group. We believe that histologic cell type had no impact in low-risk early-stage cervical cancer patients. However, in the intermediate-high-risk groups, SCC is a more favourable factor for survival than AC/ASC.
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Affiliation(s)
- Nutthaporn Chandeying
- a Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine , Prince of Songkla University , Songkhla , Thailand
| | - Jitti Hanprasertpong
- a Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine , Prince of Songkla University , Songkhla , Thailand
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Comparison of clinical outcomes of squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the uterine cervix after definitive radiotherapy: a population-based analysis. J Cancer Res Clin Oncol 2016; 143:115-122. [PMID: 27646608 DOI: 10.1007/s00432-016-2246-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the clinical outcomes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to IVA squamous cell carcinoma (SCC), adenocarcinoma (AC), and adenosquamous carcinoma (ASC) of the uterine cervix after definitive radiotherapy. METHODS Patients with a primary diagnosis of FIGO stage I-IVA SCC, AC, and ASC of the uterine cervix who had undergone definitive beam radiation with implants or isotopes between 1988 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression analyses were performed to analyze the effect of histologic subtype on cause-specific survival (CSS) and overall survival (OS). RESULTS A total of 8751 were identified, and 86.0, 10.6, and 3.4 % of patients were SCC, AC, and ASC, respectively. AC patients were more often well differentiated, while more patients were poorly/undifferentiated in ASC subtype. A higher percentage of AC and ASC patients were stage I, and fewer had stage III compared to SCC. Univariate and multivariate Cox analyses showed that histologic subtype was an independent prognostic factor for CSS and OS. SCC subtype had a better CSS and OS compared to AC and ASC subtype. The survival between AC and ASC had no significant difference. The impact of the histologic subtype on CSS and OS was not affected by FIGO stage and the year of diagnosis. CONCLUSION AC and ASC subtypes are independent prognostic factors for cervical cancer patients treated with definitive radiotherapy. AC and ASC subtypes are associated with poor survival outcomes than those with SCC.
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Lee JY, Lee C, Hahn SK, Kim HS, Chung HH, Kim JW, Park NH, Song YS. A Comparison of Adenosquamous Carcinoma and Adenocarcinoma of the Cervix after Radical Hysterectomy. Gynecol Obstet Invest 2015; 80:15-20. [PMID: 25661329 DOI: 10.1159/000369387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to compare the survival outcomes of adenocarcinoma and adenosquamous carcinoma in early-stage cervical cancer patients after radical hysterectomy. METHODS A retrospective analysis was performed of stage IB-IIA cervical cancer patients with adenocarcinoma or adenosquamous carcinoma who underwent radical hysterectomy at Seoul National University Hospital between 1998 and 2008. RESULTS A total of 166 patients with adenosquamous carcinoma (ASC) (n = 38) and adenocarcinoma (AC) (n = 128) were identified. In terms of baseline characteristics, the ASC group had higher rates of lymph node metastasis, deep stromal invasion, and lymphovascular space invasion than the AC group. However, there was no significant difference between the two histological subtypes in terms of recurrence-free survival (p = 0.396) and overall survival (p = 0.223). Patients with ASC showed similar outcomes to those with AC when limiting to either an intermediate/high-risk group or patients who underwent adjuvant concurrent chemoradiotherapy. CONCLUSION Although the ASC group presented poorer pathologic findings after radical hysterectomy compared with the AC group, there was no significant difference in survival outcomes. This suggests that intermediate/high-risk patients with ASC may be successfully treated with postoperative concurrent chemoradiotherapy.
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Affiliation(s)
- Jung-Yun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Comparison of adenocarcinoma and adenosquamous carcinoma in patients with early-stage cervical cancer after radical surgery. Gynecol Oncol 2014; 135:462-7. [PMID: 25312397 DOI: 10.1016/j.ygyno.2014.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare outcomes after radical hysterectomy in patients with stage IB1 adenocarcinoma (AdCa) and adenosquamous carcinoma (AdSCCa) of the uterine cervix. METHODS We performed a retrospective analysis of 265 patients with AdCa and 72 patients with AdSCCa. Demographic, clinicopathologic, surgical, and follow-up data were compared. RESULTS There were no differences in demographic and clinicopathologic characteristics between the two histologic types (AdCa vs. AdSCCa). Only mean size of tumor and lymphovascular space invasion was larger and more frequent in AdSCCa (2.7 cm vs 2.3 cm, P=0.019 & 29.2% vs 14.7%, P=0.008). After a median follow-up time of 68 months, 39 (14.7%) and 13 (18.1%) AdCa and AdSCCa patients, respectively, had recurrent disease (P=0.467), and 33 (12.5%) and 11 (15.3%) patients, respectively, died of their disease (P=0.555). 5-year RFS rates were 89% and 85% (P=0.582), respectively, and 5-year OS rates were 93% and 89% (P=0.787). Histologic type had no clinical impact on RFS and OS in multivariate analysis adjusting for significant prognostic factors. There were no differences in pattern of recurrence and time to recurrence between the two histologic types. When patients were stratified into three risk groups according to the criteria of GOG protocols 92 and 109, histologic type had no clinical impact on RFS and OS in any of the risk groups. CONCLUSION There are no differences in clinicopathologic factors, patterns of recurrence, time to recurrence, RFS and OS between patients with AdCa and AdSCCa.
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Prognosis of Adenosquamous Carcinoma Compared With Adenocarcinoma in Uterine Cervical Cancer: A Systematic Review and Meta-Analysis of Observational Studies. Int J Gynecol Cancer 2014; 24:289-94. [DOI: 10.1097/igc.0000000000000063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ObjectiveThe aim of this study was to compare the survival outcomes of adenosquamous carcinoma (ASC) and adenocarcinoma (AC) of the cervix.MethodsWe searched PubMed and Embase for observational studies that compared the outcomes of 2 histologic subtypes. Hazards ratios (HRs) with 95% confidence intervals (CIs) were calculated with a fixed effects model.ResultsA total of 17 studies were included in the analyses. Patients with ASC were associated significantly with poorer overall survival (death HR, 1.27; 95% CI, 1.12–1.43; I2= 0%) and recurrence-free survival (recurrence HR, 1.43; 95% CI, 1.05–1.95; I2= 19.4%) than those with AC. For clinical stages I and II in particular, ASC predicted significantly poorer outcomes compared with AC (death HR, 1.41; 95% CI, 1.17–1.70; I2= 0%).ConclusionsThis meta-analysis suggests that ASC may have poorer outcomes compared with AC of the cervix.
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Noh JM, Park W, Kim YS, Kim JY, Kim HJ, Kim J, Kim JH, Yoon MS, Choi JH, Yoon WS, Kim JY, Huh SJ. Comparison of clinical outcomes of adenocarcinoma and adenosquamous carcinoma in uterine cervical cancer patients receiving surgical resection followed by radiotherapy: a multicenter retrospective study (KROG 13-10). Gynecol Oncol 2014; 132:618-23. [PMID: 24486605 DOI: 10.1016/j.ygyno.2014.01.043] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/20/2014] [Accepted: 01/23/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the prognostic influence of adenocarcinoma (AC) and adenosquamous carcinoma (ASC) in patients with FIGO stage IB-IIA cervical cancer who received radical hysterectomy followed by adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). METHODS We analyzed 1323 patients who satisfied the following criteria: histologically proven squamous cell carcinoma (SCC), AC, or ASC of the uterine cervix; FIGO stage IB-IIA disease; no history of neoadjuvant chemotherapy; and a history of radical hysterectomy with pelvic lymph node (PLN) dissection, followed by postoperative pelvic RT at a dose ≥ 45 Gy. The median age was 50 years. Median RT dose delivered to the whole pelvis was 50.4 Gy, and 219 (16.6%) patients received brachytherapy at a median dose of 24 Gy. Concurrent chemotherapy was delivered to 492 (37.2%) patients. RESULTS Pathologic risk factors were not different according to pathologic subtype. The median follow-up duration was 75.7 months. Locoregional recurrence-free survival, relapse-free survival (RFS), and overall survival were significantly affected by histology, tumor size, PLN metastasis, parametrial invasion, lymphovascular invasion, and deep stromal invasion. The 5-year RFS rates were 83.7%, 66.5%, and 79.6% in patients with SCC, AC, and ASC histology, respectively (P<0.0001). By multivariate analysis, AC histology was the only significant prognostic factor affecting all survival outcomes. CONCLUSIONS AC histology was associated with poor survival outcomes in patients with FIGO stage IB-IIA cervical cancer who received adjuvant RT or CCRT. Prognosis of ASC histology was closer to that of SCC histology than that of AC histology.
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Affiliation(s)
- Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Joo-Young Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - Juree Kim
- Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, 17, Seoae-ro 1-gil, Jung-gu, Seoul 100-380, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, 56, Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea
| | - Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-763, Republic of Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 425-807, Republic of Korea
| | - Ji-Yoon Kim
- Department of Radiation Oncology, Yeoeuido St. Mary's Hospital, The Catholic University of Korea College of Medicine, 10, 63-ro, Yeongdeungpo-gu, Seoul 150-713, Republic of Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea
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van den Tillaart SAHM, Corver WE, Ruano Neto D, ter Haar NT, Goeman JJ, Trimbos JBMZ, Fleuren GJ, Oosting J. Loss of heterozygosity and copy number alterations in flow-sorted bulky cervical cancer. PLoS One 2013; 8:e67414. [PMID: 23874418 PMCID: PMC3706587 DOI: 10.1371/journal.pone.0067414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 05/20/2013] [Indexed: 01/05/2023] Open
Abstract
Treatment choices for cervical cancer are primarily based on clinical FIGO stage and the post-operative evaluation of prognostic parameters including tumor diameter, parametrial and lymph node involvement, vaso-invasion, infiltration depth, and histological type. The aim of this study was to evaluate genomic changes in bulky cervical tumors and their relation to clinical parameters, using single nucleotide polymorphism (SNP)-analysis. Flow-sorted tumor cells and patient-matched normal cells were extracted from 81 bulky cervical tumors. DNA-index (DI) measurement and whole genome SNP-analysis were performed. Data were analyzed to detect copy number alterations (CNA) and allelic balance state: balanced, imbalanced or pure LOH, and their relation to clinical parameters. The DI varied from 0.92–2.56. Pure LOH was found in ≥40% of samples on chromosome-arms 3p, 4p, 6p, 6q, and 11q, CN gains in >20% on 1q, 3q, 5p, 8q, and 20q, and losses on 2q, 3p, 4p, 11q, and 13q. Over 40% showed gain on 3q. The only significant differences were found between histological types (squamous, adeno and adenosquamous) in the lesser allele intensity ratio (LAIR) (p = 0.035) and in the CNA analysis (p = 0.011). More losses were found on chromosome-arm 2q (FDR = 0.004) in squamous tumors and more gains on 7p, 7q, and 9p in adenosquamous tumors (FDR = 0.006, FDR = 0.004, and FDR = 0.029). Whole genome analysis of bulky cervical cancer shows widespread changes in allelic balance and CN. The overall genetic changes and CNA on specific chromosome-arms differed between histological types. No relation was found with the clinical parameters that currently dictate treatment choice.
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Ram H, Kumar M, Bhatt MLB, Shadab M. Oral metastases from carcinoma of cervix. BMJ Case Rep 2013; 2013:bcr-2013-010020. [PMID: 23771978 DOI: 10.1136/bcr-2013-010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Metastatic tumours of the oral cavity are uncommon, they may occur in soft tissue as well as in bone in the oropharyngeal region. Owing to its rarity, metastatic tumours of the oral regions are a challenge to diagnose. We report a case of metastasis of the oral cavity, arising from uterine cervix mimicking as mucoepidermoid carcinoma. The metastatic lesions were noticed in the soft tissue of the lower buccal and gingival side of a oral cavity, in a 40-year-old woman with history of an adenosquamous carcinoma of uterine cervix treated by panhysterectomy.
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Affiliation(s)
- Hari Ram
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Kuji S, Hirashima Y, Nakayama H, Nishio S, Otsuki T, Nagamitsu Y, Tanaka N, Ito K, Teramoto N, Yamada T. Diagnosis, clinicopathologic features, treatment, and prognosis of small cell carcinoma of the uterine cervix; Kansai Clinical Oncology Group/Intergroup study in Japan. Gynecol Oncol 2013; 129:522-7. [PMID: 23480872 DOI: 10.1016/j.ygyno.2013.02.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/15/2013] [Accepted: 02/19/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This is a multicenter, collaborative study to accumulate cases of small cell carcinoma of the uterine cervix (SmCC), to clarify its clinical and clinicopathologic features and prognosis, and to obtain findings to establish future individualized treatment. METHODS At medical centers participating in the Kansai Clinical Oncology Group/Intergroup, patients diagnosed with SmCC between 1997 and 2007 were enrolled. Clinicopathologic features and prognosis were retrospectively evaluated in patients with SmCC diagnosed at a central pathologic review. RESULTS A total of 71 patients were registered at 25 medical centers in Japan. Of these, 52 patients (73%) were diagnosed with SmCC based on a pathological review. These 52 patients diagnosed with SmCC were analyzed. The median follow-up period was 57 months. The 4-year progression-free survival (PFS) was: IB1, 59%; IB2, 68%; IIB, 13%; and IIIB, 17%. The 4-year overall survival (OS) was: IB1, 63%; IB2, 67%; IIB, 30%; IIIB, 29%; and IVB, 25%. For postoperative adjuvant therapy, postoperative chemotherapy (a platinum drug in all cases) was compared to non-chemotherapy. The 4-year PFS was 65% and 14%, and the 4-year OS was 65% and 29%. PFS was significantly better (p=0.002), and the OS tended to be better (p=0.073) in the group with postoperative chemotherapy. CONCLUSION Even in patients with early stage SmCC, the prognosis is poor. However, in early stage patients, by adding postoperative chemotherapy, the prognosis may improve. Currently, various treatment protocols are used at each medical center, but in the future, a standardized treatment protocol for SmCC will hopefully be established.
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Affiliation(s)
- Shiho Kuji
- Division of gynecology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
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Comparison of the Prognoses of FIGO Stage I to Stage II Adenosquamous Carcinoma and Adenocarcinoma of the Uterine Cervix Treated With Radical Hysterectomy. Int J Gynecol Cancer 2012; 22:1389-97. [DOI: 10.1097/igc.0b013e31826b5d9b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesTo evaluate the significance of adenosquamous carcinoma (ASC) compared with adenocarcinoma (AC) in the survival of surgically treated early-stage cervical cancer.MethodsWe retrospectively reviewed the medical records of 163 patients with International Federation of Gynecology and Obstetrics stage IA2 to stage IIB cervical cancer who had been treated with radical hysterectomy with or without adjuvant radiotherapy between January 1998 and December 2008. The patients were classified according to the following: (1) histological subtype (ASC group or AC group) and (2) pathological risk factors (low-risk or intermediate/high-risk group). Survival was evaluated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis of progression-free survival (PFS) was performed using the Cox proportional hazards regression model to investigate the prognostic significance of histological subtype.ResultsClinicopathological characteristics were similar between the ASC and AC histology groups. Patients with the ASC histology displayed a PFS rate similar to that of the patients with the AC histology in both the low-risk and intermediate/high-risk groups. Neither the recurrence rate nor the pattern of recurrence differed between the ASC group and the AC group. Univariate analysis revealed that patients with pelvic lymph node metastasis and parametrial invasion achieved significantly shorter PFS than those without these risk factors.ConclusionsCharacteristics of the patients and the tumors as well as survival outcomes of ASC were comparable to adenocarcinoma of early-stage uterine cervix treated with radical hysterectomy. Our results in part support that the management of ASC could be the same as the one of AC of the uterine cervix.
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Vandenbroucke L, Robert AL, Lavoué V, Foucher F, Henno S, Levêque J. [Adenocarcinoma of the uterine cervix: particularities in diagnosis and treatment]. ACTA ACUST UNITED AC 2012; 42:207-16. [PMID: 22921356 DOI: 10.1016/j.jgyn.2012.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/01/2012] [Accepted: 07/13/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The adenocarcinoma of the uterine cervix accounts for 10 to 20% of the premalignant and malignant lesions and is different from the cervical intraepithelial neoplasia and invasive squamous cell carcinoma. MATERIALS AND METHODS Recent literature review (from 1985 to 2012) based on the literature available. RESULTS AND DISCUSSION Adenocarcinoma in situ is an induced HPV lesion (role of HPV 18) of the glandular epithelium: its preferential endocervical situation explains the difficulties in the diagnosis and follow-up after conservative treatment. If the hysterectomy remains the gold standard for treatment, the conservative treatments (resection in sano of the lesions with margins of more than 1cm, meticulous study of the operative specimen, compliance with the follow-up) are possible in the young patients who desire to preserve their fertility. The invasive adenocarcinoma is characterized by a more difficult diagnosis because of its endocervical development, and a prognosis less favorable when compared to squamous cell carcinoma with a greater frequency of the lymphatic node involvement and metastatic diffusion. Its treatment must take into account the particular gravity of the factors of worse prognosis (FIGO stage, tumor size, lymphatic node spreading, adenosquamous histological subtype) in particular in the advanced stages and includes beside the surgery, radiotherapy and chemotherapy.
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Affiliation(s)
- L Vandenbroucke
- Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France
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Qiu JT, Abdullah NA, Chou HH, Lin CT, Jung SM, Wang CC, Chen MY, Huang KG, Chang TC, Lai CH. Outcomes and prognosis of patients with recurrent cervical cancer after radical hysterectomy. Gynecol Oncol 2012; 127:472-7. [PMID: 22902919 DOI: 10.1016/j.ygyno.2012.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/29/2012] [Accepted: 08/07/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Our aim was to investigate the clinical features and outcomes following recurrence after primary radical hysterectomy for cervical cancer. METHODS Clinical data of 121 documented recurrent cervical cancer patients who received primary radical hysterectomy and bilateral pelvic lymphadenectomy between 1993 and 2000 at Chang Gung Memorial Hospital were retrospectively reviewed. Clinicopathological variables, primary treatment, failure pattern, salvage treatment and outcomes were analyzed. Outcomes of the current study were compared to those treated between 1982 and 1992 (1982-1992 cohort). RESULTS Cancer recurrence was documented at a median time to recurrence (TTR) of 28.4 months (1.2-129.9 months). Assessable failure patterns (n=106) included loco-regional in 46.3%, distant in 47.2% and combined pelvic-distant in 6.6%. 5-year survival of the 121 patients was 22.3% after cancer recurrence. The median survival after recurrence (SAR) was 16.4 months (range 0-144.2 months). By multivariate analysis, extravaginal sites of recurrence (HR 2.56, 1.28-5.12; p=0.008) and HPV16-positive (HR 0.60, 0.38-0.96; p=0.033) were significant prognostic factors for SAR. Non-squamous histology or pelvic node metastasis at primary surgery were not significant (5-year SAR of 16.4% and 20.0%, respectively), though they were (0% and 0%) in the 1993-2000 cohort. Salvage surgery and concurrent chemoradiation were more frequently used in the 1993-2000 cohort (48.3% versus 12.4%). CONCLUSION HPV16-negativity and extravaginal relapse were significant poor prognostic factors. Future randomized controlled trials for recurrent cervical cancer could be stratified for these two factors if further studies using external validation confirm these results.
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Affiliation(s)
- Jian-Tai Qiu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Chen JLY, Cheng JCH, Kuo SH, Chen CA, Lin MC, Huang CY. Outcome analysis of cervical adenosquamous carcinoma compared with adenocarcinoma. Acta Obstet Gynecol Scand 2012; 91:1158-66. [PMID: 22497449 DOI: 10.1111/j.1600-0412.2012.01420.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare survival between patients with cervical adenocarcinoma (AC) and adenosquamous carcinoma (ASC). DESIGN Retrospective study. SETTING National Taiwan University Hospital, Taipei, Taiwan. POPULATION All patients with cervical AC or ASC who received definitive treatment from January 1995 to December 2009. METHODS Medical and histopathological record review. MAIN OUTCOME MEASURES Overall and recurrence-free survival. RESULTS A total of 170 women received a histological diagnosis of AC and 42 of ASC. The median follow-up was 56.7 months. There were no significant differences in age, International Federation of Gynecology and Obstetrics (FIGO) stage, gravidity or treatment modality between women with AC and ASC. Patients with ASC had a higher percentage of poorly differentiated tumors than those with AC (33.3 vs. 15.3%, respectively; p= 0.014). Five year overall and recurrence-free survival was 66.8 and 58.9%, respectively, for women with AC and 69.5 and 61.9%, respectively, for those with ASC (p= 0.795 and p= 0.892, respectively). Survival outcomes in patients with early or advanced stage disease did not differ between the histological groups. No differences in failure patterns were found between the two groups. The FIGO stage and treatment modality were factors which affected overall and recurrence-free survival. CONCLUSIONS We did not find evidence to suggest that ASC subtypes indicate worse outcome. Cervical ASC could be categorized as one subtype of AC. The FIGO stage and treatment modalities have greater influence on outcomes than histological subtype.
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Affiliation(s)
- Jenny Ling-Yu Chen
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Rudtanasudjatum K, Charoenkwan K, Khunamornpong S, Siriaunkgul S. Impact of histology on prognosis of patients with early-stage cervical cancer treated with radical surgery. Int J Gynaecol Obstet 2011; 115:183-7. [PMID: 21885048 DOI: 10.1016/j.ijgo.2011.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/16/2011] [Accepted: 07/28/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the effect of carcinoma cell type on tumor characteristics, tumor spread, tumor recurrence, and survival of patients with early-stage cervical cancer who had radical hysterectomy and pelvic lymphadenectomy. METHOD Data from 499 patients with stage IA to IIA cervical carcinoma who received primary surgical treatment from 2003 to 2005 at Chiang Mai University were retrospectively reviewed with regard to 3 histologic types; squamous cell carcinoma (SCC), adenocarcinoma (AC), and adenosquamous carcinoma (AS). RESULTS Among the 499 patients, 71.1% had SCC, 23.4% had AC, and 5.4% had AS. There was no significant difference in stage, tumor size, tumor characteristics, or rate of loco-regional spread. A higher proportion of women with SCC needed adjuvant radiation (P=0.001). Five-year recurrence-free survival (RFS) and overall survival (OS) were comparable among the groups. Among patients with pelvic node metastasis, 5-year RFS and OS were significantly lower in those with AC than in those with SCC (RFS, 66.1% versus 86.4%, P=0.02; OS, 68.2% versus 88.2%, P=0.05). CONCLUSION There was no difference among SCC, AC, and AS in most tumor characteristics, spread, recurrence, and survival in patients with early-stage cervical cancer. Among patients with pelvic lymph node metastasis, AC was associated with less favorable outcomes than SCC.
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Affiliation(s)
- Korapin Rudtanasudjatum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Outcomes of patients undergoing radical hysterectomy for cervical cancer of high-risk histological subtypes. Int J Gynecol Cancer 2011; 21:123-7. [PMID: 21178574 DOI: 10.1097/igc.0b013e3181ffccc1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The most common types of cervical cancer are squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma, referred to here collectively as SA cervical cancer. Other types of cervical cancer, referred to here collectively as nonsquamous/nonadenocarcinoma (NSNA) cervical cancer, include neuroendocrine, small cell, clear cell, sarcomatoid, and serous tumors. Anecdotally, NSNA tumors seem to have a worse prognosis than their SA counterparts. We sought to determine whether patients with early-stage NSNA have a worse prognosis than those with early-stage SA cervical cancer. METHODS We retrospectively reviewed charts of women with stage IA1-IB2 NSNA cervical cancer treated by radical hysterectomy and lymph node staging at M. D. Anderson Cancer Center from 1990 to 2006. The NSNA patients were matched 1:2 to patients with grade 3 SA lesions on the basis of stage, age at diagnosis, tumor size, and date of diagnosis. RESULTS Eighteen patients with NSNA primary cervical cancer subtypes (neuroendocrine [n = 7], small cell [n = 5], clear cell [n = 4], papillary serous [n = 1], and sarcomatoid [n = 1]) were matched to 36 patients with grade 3 SA lesions. There were no differences between the 2 groups in age, body mass index, clinical stage, or lesion size. The 2 groups also did not differ with respect to number of nodes resected, lymphovascular space invasion, margin status, lymph node metastasis, or adjuvant radiation therapy or chemotherapy. At a median follow-up of 44 months, median progression-free and overall survivals had not been reached; however, both progression-free survival (P = 0.018) and overall survival (P = 0.028) were worse for the NSNA group. The 5-year progression-free and overall survival rates were 61.2% and 67.6%, respectively, for the NSNA group, compared with 90.1% and 88.3%, respectively, for the SA group. CONCLUSIONS Patients with early-stage NSNA cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy have a worse prognosis than patients with grade 3 SA lesions. Patients with NSNA tumors may require a multimodality approach to their cancer care.
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Class II radical hysterectomy for stage I-IIA cervix cancer: Prognostic factors associated to recurrence and survival in a northeast Brazil experience. J Surg Oncol 2011; 104:255-9. [DOI: 10.1002/jso.21939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/16/2011] [Indexed: 11/07/2022]
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Cibula D, Pinkavova I, Dusek L, Slama J, Zikan M, Fischerova D, Freitag P, Dundr P. Local Control After Tailored Surgical Treatment of Early Cervical Cancer. Int J Gynecol Cancer 2011; 21:690-8. [DOI: 10.1097/igc.0b013e318213653d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background:It was the aim of our study to analyze oncological outcome and prognostic parameters in patients with early stages cervical cancer after tailored and well-standardized surgical treatment with an adequate follow-up.Methods:Oncological outcome and prognostic parameters were evaluated in a group of 192 patients with cervical cancer stages IA2 to 2B who had undergone radical hysterectomy (n = 171), radical parametrectomy (n = 12), or radical trachelectomy (n = 9). Procedures were classified as type B (n = 72), type C1 nerve sparing (n = 103), or type C2 (n = 17).Results:Event-free and overall 5-year survivals probabilities reached 92.7% (confidence interval, 89.5%-95.9 %) and 94.1% (confidence interval, 90.9%-97.3 %). There was only 1 isolated pelvic recurrence found of the total of 10 recurrences. Adjuvant radiotherapy was given to only 22% of patients. The most significant independent prognostic parameters in stage IB tumors were lymph node status, histological type, and tumor volume, whereas in stage II, the parameters included histological type and tumor volume, the latter being inversely related to the prognosis.Conclusions:We have shown an excellent prognosis, especially local control, after tailored surgical treatment of stages IA2 to IIB of cervical cancer, with low prevalence of adjuvant treatment. Different prognostic parameters were observed for stages IB1/IB2 and IIA/B.
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Lee YY, Choi CH, Kim TJ, Lee JW, Kim BG, Lee JH, Bae DS. A comparison of pure adenocarcinoma and squamous cell carcinoma of the cervix after radical hysterectomy in stage IB-IIA. Gynecol Oncol 2010; 120:439-43. [PMID: 21145099 DOI: 10.1016/j.ygyno.2010.11.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/15/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study was designed to investigate the survival difference between pure adenocarcinoma (AC) and squamous cell carcinoma (SCC) in early cervical cancer (FIGO stage IB-IIA) after radical hysterectomy with or without adjuvant therapy performed at a single institution. METHODS Patients with AC or SCC between November 1994 and September 2007 at the Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, Korea were evaluated. RESULTS Among the 775 patients, 636 patients had SCC, and 139 patients had pure AC. In basal characteristics, preoperative FIGO stage, adjuvant therapy after surgery, as well as chemotherapeutic regimens, were not different between the two groups. However, the median age was about 5 years younger in pure AC patients than in SCC patients (44 years vs. 49 years, P=.001). In the comparison of pathological findings after surgery between the two groups, there were no differences between the two groups, except for LVSI status. The recurrence rate was higher in the pure AC group than in the SCC group (SCC; 36/636; 5.7%, AC; 20/139; 14.4%, P=<0.001, respectively). The pure AC group had a higher recurrence rate in hematogenous/distant areas than the SCC group (SCC: 8/36; 22.2%, AC; 9/20; 45.0%, P=.076, respectively). In multivariable analysis, positive for pelvic LN and the pure AC cell type were independent factors in both DFS and OS. CONCLUSION We observed that pure AC of the cervix might entail a worse survival outcome than SCC in patients with early cervical cancer (IB-IIA).
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Affiliation(s)
- Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Republic of Korea
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Kodama J, Seki N, Masahiro S, Kusumoto T, Nakamura K, Hongo A, Hiramatsu Y. Prognostic factors in stage IB-IIB cervical adenocarcinoma patients treated with radical hysterectomy and pelvic lymphadenectomy. J Surg Oncol 2010; 101:413-7. [PMID: 20127891 DOI: 10.1002/jso.21499] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The purpose of the present study was to identify prognostic factors and patterns of recurrence in patients with stage IB-IIB cervical adenocarcinoma who had undergone radical surgery and to compare these patterns with those observed in squamous cell carcinoma (SCC) patients. METHODS We retrospectively reviewed 303 patients (97 with adenocarcinoma and 206 with SCC) with stage IB-IIB cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy. RESULTS In the case of the adenocarcinoma patients, lymph node metastasis and parametrial invasion were independent indicators of disease-free survival, whereas lymph node metastasis was the only independent prognostic factor for the overall survival of the patients. The sites of recurrence did not significantly differ between the adenocarcinoma and SCC patients. In parametrium-positive patients, adenocarcinoma was found to be an independent prognostic factor for disease-free survival. In patients with positive pelvic lymph node, adenocarcinoma was found to be an independent prognostic factor for both disease-free and overall survival. CONCLUSIONS Adenocarcinoma was found to be an independent prognostic factor for survival in patients with positive pelvic node or parametrial extension. Furthermore, the patterns of recurrence did not differ significantly between the adenocarcinoma and SCC patients.
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Affiliation(s)
- Junichi Kodama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Adenocarcinoma: a unique cervical cancer. Gynecol Oncol 2009; 116:140-6. [PMID: 19880165 DOI: 10.1016/j.ygyno.2009.09.040] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/22/2009] [Accepted: 09/26/2009] [Indexed: 12/31/2022]
Abstract
Adenocarcinoma of the cervix constitutes only approximately 20% of all cervical carcinomas; therefore, specific Level 1 evidence to guide patient management is lacking. Most trials have included this histologic subtype but in insufficient numbers to do more than generate hypotheses from subset analyses. As a consequence, our understanding of the natural history and optimal management of adenocarcinoma of the cervix is limited. The optimal management of adenocarcinoma of the cervix continues to be a subject of debate among practitioners as to whether or not it should be different from squamous cell carcinoma and what would constitute this management. The purpose of this review was to give an overview of the current knowledge on adenocarcinoma of the cervix and its differences from squamous cell carcinoma with regard to risk factors, prognosis, survival rates, patterns of recurrence, and response to treatment. This article will focus on possible specific therapeutic directions to explore in the management of locally advanced adenocarcinomas.
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Parametrial Involvement in Radical Hysterectomy Specimens for Women With Early-Stage Cervical Cancer. Obstet Gynecol 2009; 114:93-99. [DOI: 10.1097/aog.0b013e3181ab474d] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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