Adenosquamous histology predicts poor outcome in low-risk stage IB1 cervical adenocarcinoma Jayanthi S. Lea, M.D., a Robert L. Coleman, M.D., a Elizabeth O. Garner, M.D., b Linda R. Duska, M.D., c David S. Miller, M.D., a and John O. Schorge, M.D. a, * a Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA b Brigham and Women’s Hospital, Boston, MA 02115, USA c Massachusetts General Hospital, Boston, MA 02114, USA Received 6 March 2003 Abstract Objective. The purpose of this study was to identify poor prognostic factors of low-risk stage IB1 cervical adenocarcinoma. Methods. All women diagnosed with stage IB1 cervical adenocarcinoma between 1982 and 2002 were identified at our three institutions. Data were extracted from medical records. Patients were retrospectively assigned to a low- or intermediate/high-risk cohort based on the surgical-pathologic eligibility criteria of two randomized controlled trials of adjuvant therapy in early stage cervical cancer, Gynecologic Oncology Group protocols 92 and 109. Multivariate analysis was performed. Results. Two hundred thirty women diagnosed with stage IB1 cervical adenocarcinoma had an overall 5-year survival of 89%. Adenosquamous cell type (P  0.01) was the only independent risk factor of disease recurrence in the low-risk group (n = 178). The 5-year disease-free survival for low-risk adenosquamous patients was 79%, compared to 96% for other histologic subtypes (P  0.01). Low-risk case subjects developed fewer disease recurrences than those in the intermediate/high-risk (n = 52) category (7% vs 46%; P  0.01). The 5-year disease-free survival for intermediate/high-risk patients was 51% and no additional risk factors were identified. Conclusion. Adenosquamous histology is predictive of disease recurrence and decreased survival in low-risk stage IB1 cervical adenocarcinoma. This risk factor should be considered in future clinical trials of adjuvant therapy. © 2003 Elsevier Inc. All rights reserved. Introduction Cervical adenocarcinoma is increasing in incidence and currently accounts for approximately 24% of all cervical cancers diagnosed in the United States each year [1]. These tumors may exhibit unique biological behavior and response to therapy compared to their squamous counterparts [2,3]. Stage IB cervical adenocarcinomas have been suggested to have a poorer prognosis in some reports, but other investi- gators have found no difference [4 –7]. However, most com- parison studies did not separate adenocarcinomas from those tumors with adenosquamous cell type. In a prospec- tive Gynecologic Oncology Group (GOG) study of stage IB cervical cancer, Look et al. compared the influence of all three cell types on recurrence-free interval and survival. Patients with adenosquamous cell type had a worse prog- nosis than those with adenocarcinomas or squamous cell cancers [7]. GOG protocol 92 demonstrated that adjuvant radiother- apy improved disease-free survival (DFS) in patients with stage IB cervical cancer and surgical-pathologic factors, including large clinical tumor size, capillary lymphatic space involvement (CLS), and deep stromal invasion [8]. GOG protocol 109/Southwest Oncology Group protocol 8797 showed that adjuvant chemoradiation resulted in a significant improvement in the survival of stage IA2–IIA cervical cancer patients with nodal metastases, positive sur- * Corresponding author. Division of Gynecologic Oncology, Depart- ment of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., J7.124, Dallas, TX 75390-9032. Fax: +1-214- 648-8404. E-mail address: john.schorge@utsouthwestern.edu (J.O. Schorge). R Available online at www.sciencedirect.com Gynecologic Oncology 91 (2003) 558 –562 www.elsevier.com/locate/ygyno 0090-8258/$ – see front matter © 2003 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2003.08.020