Prognostic Impact of Histology in Patients with Cervical Squamous Cell Carcinoma, Adenocarcinoma and Small Cell Neuroendocrine Carcinoma

Background: Clarifying the prognostic impact of histological type is an essential issue that may influence thetreatment and follow-up planning of newly diagnosed cervical cancer cases. This study aimed to evaluate theprognostic impact of histological type on survival and mortality in patients with cervical squamous cell carcinoma(SCC), adenocarcinoma (ADC) and small cell neuroendocrine carcinoma (SNEC). Materials and
Methods:All patients with cervical cancer diagnosed and treated at Chiang Mai University Hospital between January1995 and October 2011 were eligible. We included all patients with SNEC and a random weighted sample ofpatients with SCC and ADC. We used competing-risks regression analysis to evaluate the association betweenhistological type and cancer-specific survival and mortality.
Results: Of all 2,108 patients, 1,632 (77.4%) hadSCC, 346 (16.4%) had ADC and 130 (6.2%) had SNEC. Overall, five-year cancer-specific survival was 60.0%,54.7%, and 48.4% in patients with SCC, ADC and SNEC, respectively. After adjusting for other clinical andpathological factors, patients with SNEC and ADC had higher risk of cancer-related death compared with SCCpatients (hazard ratio [HR] 2.6; 95% CI, 1.9-3.5 and HR 1.3; 95% CI, 1.1-1.5, respectively). Patients with SNECwere younger and had higher risk of cancer-related death in both early and advanced stages compared with SCCpatients (HR 4.9; 95% CI, 2.7-9.1 and HR 2.5; 95% CI, 1.7-3.5, respectively). Those with advanced-stage ADChad a greater risk of cancer-related death (HR 1.4; 95% CI, 1.2-1.7) compared with those with advanced-stageSCC, while no significant difference was observed in patients with early stage lesions.
Conclusion: Histologicaltype is an important prognostic factor among patients with cervical cancer in Thailand. Though patients withSNEC were younger and more often had a diagnosis of early stage compared with ADC and SCC, SNEC wasassociated with poorest survival. ADC was associated with poorer survival compared with SCC in advancedstages, while no difference was observed at early stages. Further tailored treatment-strategies and follow-upplanning among patients with different histological types should be considered.