Locally advanced cervical carcinoma patients treated with chemoradiation followed by radical surgery: clinical response and oncological outcomes according to histotype after propensity score analysis.

Abstract

INTRODUCTION:

The aims of this study were to analyze the pathological response, and survival outcomes of adenocarcinoma/adenosquamous (AC/ASC) versus squamous cell carcinoma (SCC) in patients with locally advanced cervical cancer (LACC) managed by chemoradiotherapy followed by radical surgery.

METHODS:

Retrospective, multicenter, observational study, including patients with SCC and AC/ACS LACC patients treated with preoperative CT/RT followed by tailored radical surgery (RS) between 06/2002 and 05/2017. Clinical-pathological characteristics were compared between patients with SCC versus AC/ASC. A 1:3 ratio propensity score (PS) matching was applied to remove the variables imbalance between the two groups.

RESULTS:

After PS, 320 patients were included, of which 240 (75.0%) in the SCC group, and 80 (25.0%) in the AC/ASC group. Clinico-pathological and surgical baseline characteristics were balanced between the two study groups. Percentage of pathologic complete response was 47.5% in SCC patients versus 22.4% of AC/ASC ones (p < 0.001). With a median follow-up of 51 months (range:1-199), there were 54/240 (22.5%) recurrences in SCC versus 28/80 (35.0%) in AC/ASC patients (p = 0.027). AC/ASC patients experienced worse disease free (DFS), and overall survival (OS) compared to SCC patients (p = 0.019, and p = 0.048, respectively). In multivariate analysis, AC/ACS histotype, and FIGO stage were associated with worse DFS and OS.

CONCLUSION:

In LACC patients treated with CT/RT followed by RS, AC/ASC histology was associated with lower pathological complete response to CT/RT, and higher risk of recurrence and death compared with SCC patients. This highlights the need for specific therapeutic strategies based on molecular characterization to identify targets and develop novel treatments.

• Authors: Francesco Legge, Nicolò Bizzarri, Valerio Gallotta, Luigi Pedone Anchora, Francesco Cosentino, Luigi Carlo Turco, Camilla Certelli, Gabriella Macchia, Vincenzo Valentini, Giovanni Scambia, Gabriella Ferrandina
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 48 Issue 9 Pg. 2045-2052 (09 2022) ISSN: 1532-2157 [Electronic] England
• PMID: 35450757 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Topics

• Adenocarcinoma (pathology)
• Carcinoma, Adenosquamous (pathology)
• Carcinoma, Squamous Cell (pathology)
• Chemoradiotherapy
• Female
• Humans
• Neoplasm Staging
• Propensity Score
• Retrospective Studies
• Uterine Cervical Neoplasms (pathology)