Is there really a difference in survival of women with squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma of the cervix?

• Published in: Cancer 1995-11, Vol.76 (S10), p.1948-1955
• Main Authors: Shingleton, Hugh M., Bell, Maria C., Fremgen, Amy, Chmiel, Joan S., Russell, Anthony H., Jones, Walter B., Winchester, J David P., Clive, Rosemarie E.
• Format: Article
• Language: English
• Subjects: adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; adenosquamous cell carcinoma; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Adenosquamous - mortality; Carcinoma, Adenosquamous - pathology; Carcinoma, Adenosquamous - therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; cervical cancer; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Risk Factors; squamous cell carcinoma; survival; Survival Rate; Tumors; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19951115)76:10+<1948::AID-CNCR2820761311>3.0.CO;2-T

Background. The authors' aim was to assess whether there is a difference in biologic behavior and survival in comparing adenocarcinoma (AdCA), squamous cell carcinoma (SCC), and adenosquamous carcinoma (Ad/SC) of the cervix. Methods. Cancer registrars at 703 hospitals submitted anonymous data on 11,157 patients with cervical cancer diagnosed and/or treated in 1984 and 1990 for a Patient Care Evaluation Study of the American College of Surgeons. Among these patients, 9351 (83.8%) had SCC; 1405 (12.6%), AdCA; and 401 (3.6%), Ad/SC cancers. There were no significant changes in percentages of the different histologic types between the study years 1984 and 1990, nor was the patient distribution different regarding age, race/ethnicity, and socioeconomic background for each histologic group. Furthermore, the distribution of patients who had had a hysterectomy did not change between 1984 and 1990. Results. A larger percent of patients with SCC (63.8%) than those with Ad/SC (59.8%) or AdCA (50.2%) had tumors larger than 3 cm at greatest dimension. Early stage patients (IA, IB, IIA) often were treated by hysterectomy alone (45.5%) or combined with radiation (21.1%). The remaining patients (21.9%) received radiation alone. Of the patients with clinical stage I disease, 7.6% of Ad/CA patients, 15.5% of Ad/SC patients and 12.6% of SCC patients had positive nodes Although patients with SCC had higher survival rates for all four clinical stages (I‐IV), the differences were only significant for Stage II patients. Patients with clinical stage IB SCC and AdCA treated by surgery alone were found to have significantly better survival rates (93.1% and 94.6% at 5 years, respectively) than women treated by either radiation alone or a combination of surgery and radiation (P < 0.001, both histologic comparisons). For women with Ad/SC tumors, however, the 5‐year survival rate was 87.3% for those receiving combined treatment compared with those receiving surgery alone (69.2%) or radiation alone (79.2%). However, these survival curves were not significantly different (P = 0.496). One hundred six patients with positive nodes were available for analysis. The 5‐year survival rate of patients with SCC and positive nodes was 76.1%. Surprisingly, patients with Ad/SC and positive nodes had the highest 5‐year survival rate (85.7%), whereas, women with AdCA and positive nodes had a sharply reduced 5‐year survival rate (33.3%). The curves were significantly different(P< 0.01). For patients wit