The main histological type of cervical cancer is SCC [22]; however, the incidences of AC and ASC of the uterine cervix have increased over the past 40 years, especially among younger women [23–26]. In this retrospective cohort study, we examined the records of Chinese patients with FIGO stage IB-IIA AC or ASC, 240 with AC and 130 with ASC, to evaluate potential prognostic factors among these patients. All patients underwent surgery as the primary treatment. Multivariate analyses showed that LNM was an independent prognostic factor for OS. Previous studies showed that FIGO stage, tumour size, and LNM were independent prognostic factors for survival [10, 27, 28]. Shu et al. [29] reported that as to patients with AC/ASC, differentiation was the independent predictor of OS; and LVSI of DFS. We investigated whether histology (AC vs. ASC) is a prognostic factor in patients with cervical cancer. There were no differences, in terms of clinical impact on OS, between the two histological groups in early-stage cervical cancer, although a greater proportion of patients with ASC had LVSI and SCC-Ag > 5 ng/ml; moreover, patients with ASC were much older than those with AC. Multivariate Cox regression analysis revealed that CEA > 5 ng/ml and SCC-Ag > 5 ng/ml were independent risk factors for RFS and OS in patients with AC, but not in patients with ASC. This suggests that pre-treatment levels of CEA > 5 ng/ml and SCC-Ag > 5 ng/ml can be regarded as risk factors for AC, providing additional information for patient-tailored therapy, and should be analysed in prospective studies. Previous studies reported that elevated pre-treatment serum SCC-Ag levels were associated with poor prognosis [30, 31], but the histologic type of most patients were cervical squamous cell carcinoma; few were AC. Nakamura et al. [32] showed that AC, DOI, tumor size, and LVSI were significantly closely associated with disease recurrence
The respective 5-year survival rates for patients with stages IB and IIA were 72.7% and 56% for the AC group and 81.0% and 62% for the ASC group. Baalbergen et al. [33] reported that 5-year survival rates for patients with stages I and II (IIA, IIB) AC were 79% and 37%, respectively. Presumably because the latter group also included patients with IIB cancer, the 5-year survival rate for patients with stage II cancer was lower than the rate observed in our study. These results suggest that as FIGO stage increases, the survival time is reduced accordingly. Our results demonstrated that FIGO stage (IB vs. IIA) was significantly associated with survival time (P < 0.05). Similarly, Noh et al. [27] reported that ASC histology was associated with more favourable survival outcomes, compared to AC histology, although the differences were not statistically significant. Lai et al. [9] found no differences in RFS and CSS between the ASC and AC histology.
Wang et al. [34] demonstrated that higher tumour grade and more vascular invasion were present in patients with ASC, compared to patients with AC. Reis et al. [8] found that Grade III histology and LVSI were more common in patients with ASC than in patients with AC. In addition, they demonstrated that although the time to recurrence was shorter for patients with ASC (7.9 months vs. 15 months; P = 0.01), differences in OS or recurrence rates between patients with AC and patients with ASC were not statistically significant. Baek et al. [15] reported greater mean tumour size and more frequent LVSI in patients with ASC, but found that histologic type did not influence RFS or OS in multivariate analyses, following adjustment for significant prognostic factors. In contrast, several studies reported poor survival for patients with ASC. Lee et al. [16] demonstrated that ASC may have poorer outcomes compared with AC of the cervix in meta-analysis. Farley et al. [17] observed an increased risk of death among patients with ASC histology, compared to those with AC histology. Twu et al. [35] found that ASC seemed slightly worse than AC in univariate analysis, but they were not significantly different on RFS and CSS in multivariate analyses.
Our study demonstrated that there was a tendency for better RFS and OS in patients with ASC than those with AC in both low-risk and intermediate/high-risk groups, although not statistically significant. The prognosis for ASC histology appears to be intermediate (i.e., between the prognoses of SCC and AC histologies [28]. Previous studies showed no statistically significant differences between patients with AC and those with ASC in low-, intermediate-, or high-risk groups (P > 0.05) [6, 15, ]. However, Lea et al. reported that ASC histology was associated with reduced disease-free survival relative to AC histology, among patients with low-risk stage IB1 cancer [36]. We also examined the effect of treatment on OS in intermediate-risk patients with ASC and those with AC. Univariate analysis indicated that the CCRT groups was associated with a significantly better RFS and OS for patients with ASC. RT alone is related to RFS but not to OS. It indicated that RT alone maybe effective for local control, while CCRT have obvious advantages for distant metastasis control. In addition, the RT and CCRT groups did not show any survival benefit for patients with AC. Perhaps because there are more the radioresistance and aggressive behaviour of tumours in patients with AC relative to those with ASC. A retrospective study suggested that RT and CCRT after radical hysterectomy are not beneficial in patients with intermediate risk factors. In particular, RT and CCRT appeared to increase the incidence of lymphedemaand even lead to RT-related morbidities such as small-bowel obstruction or leg edema [37, 38]. Twu et al. confirmed that adjuvant therapy (radiotherapy with or without chemotherapy) following RH-PLND for early-stage AC/ASC patients with low prognostic score may not improve survival. Therefore, adjuvant therapy could be omitted in order to decrease morbidity [35]. We suspected that systemic CT alone could have a survival benefit for patients with AC. Takekuma et al. [39] reported chemotherapy alone after surgery for high-risk patients has similar efficacy but less toxicity than CCRT. More prospective randomized studies using larger patient populations is needed to confirm our findings.
Among the limitations of our study is its retrospective nature. As far as we known, however, it includes the largest number of patients with FIGO stage IB–IIA cervical AC/ASC who underwent radical hysterectomy, and provides enough information about prognosis and adjuvant treatment with its long follow-up period