Impact of histological subtypes on clinical outcome of endocervical adenocarcinoma

Xin Tian; Ping Liu; Shan Kang; Zhumei Cui; Lixin Sun; Jinghe Lang; Chunlin Chen

doi:10.1016/j.ejso.2024.107977

Impact of histological subtypes on clinical outcome of endocervical adenocarcinoma

Eur J Surg Oncol. 2024 Apr;50(4):107977. doi: 10.1016/j.ejso.2024.107977. Epub 2024 Jan 25.

Authors

Xin Tian¹, Ping Liu¹, Shan Kang², Zhumei Cui³, Lixin Sun⁴, Jinghe Lang⁵, Chunlin Chen⁶

Affiliations

¹ Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Department of Obstetrics and Gynaecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China.
⁴ Department of Gynecologic Oncology, Shanxi Provincial Cancer Hospital, Taiyuan, China.
⁵ Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China.
⁶ Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address: ccl1@smu.edu.cn.

PMID: 38373385
DOI: 10.1016/j.ejso.2024.107977

Abstract

Objective: This multicenter study aimed to investigate the disparity in clinical features and prognosis among different histopathologic subtypes of endocervical adenocarcinoma (EA) based on the 2014 World Health Organization (WHO) classification.

Methods: We retrieved and analyzed data from the Chinese Four C Database between 2004 and 2018. 672EA patients with radical hysterectomies from 32 institutions were retrospectively reviewed. Clinicopathologic characteristics, five-year overall survival (OS), and disease-free survival (DFS) were compared based on histological subtypes.

Results: The 5-year DFS and OS rates for usual, endometrioid, mucinous, gastric, villoglandular, clear cell/serous/mesonephric EAs were as follows: 81.3 %, 89.1 %, 63.0 %, 35.6 %, 88.6 %, 79.9 %, respectively (P < 0.0001); 87.4 %, 96.6 %, 74.7 %, 34.0 %, 96.7 %, 86.3 %, respectively (P < 0.0001). Gastric- and mucinous-type exhibited a higher frequency of lymph node metastasis, deep stromal invasion, uterine corpus invasion, and recurrence than the usual -type (recurrence rate:50.00 % vs 29.90 % vs 15.50 %, P < 0.0001). Multivariate analysis revealed gastric-type was significantly associated with inferior DFS (HR,3.018; 95 % CI, 1.688-5.397; P < 0.0001) and OS(HR, 4.114; 95 % CI, 2.002-8.453; P < 0.0001). Furthermore, compared to the usual -type, mucinous-type demonstrated significantly worse DFS (HR, 1.773; 95 % CI,1.123-2.8; P = 0.014) and OS (HR, 2.168; 95 % CI,1.214-3.873; P = 0.009) whereas endometrioid-type was an identified as independent factor for better DFS (HR, 0.365; 95 % CI,0.143-0.928; P = 0.034). Villoglandular subtype displayed similar features and favorable prognosis as the usual type.

Conclusions: Relevant clinical features and prognosis varied significantly among histological subtypes of EA, thus offering valuable guidance for the development of subtype-specific treatment strategies to optimize EA management.

Keywords: Clinical outcome; Endocervical adenocarcinoma; Histopathologic subtypes; WHO classification.

Publication types

Multicenter Study

MeSH terms

Adenocarcinoma* / pathology
Adenocarcinoma* / therapy
Disease-Free Survival
Female
Humans
Prognosis
Retrospective Studies
Uterine Cervical Neoplasms* / pathology