Thai Journal of Obstetrics and Gynaecology December 2002, Vol. 14, pp. 261-267

GYNAECOLOGY

Comparison of The Survival Rate between Squamous Cell Carcinoma and Adenocarcinoma of the Uterine Cervix Lucksana Siriraksakul MD,* Sumonmal Manusirivithaya MD,* Manit Sripramote MD,* Chantawat Sheanakul MD,* Siriwan Tangjitgamol MD,* Surawute Leelahakorn MD,* Taovalai Thavaramara MD,* Thanatip Tantivatana MD,** Ladawan Narkwong MD.** * Gynecologic Oncology Division, Department of Obstetrics and Gynecology, ** Radiation Oncology Division, Department of Radiology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok 10300, Thailand

ABSTRACT Objective To compare the survival rate between squamous cell carcinoma (SCC) and adenocarcinoma (ACA) of the uterine cervix. Design Retrospective cohort study. Settings Gynecologic Oncology Division, Radiation Oncology Division. Bangkok Metropolitan Administration (BMA) Medical College and Vajira Hospital, Bangkok,Thailand. Subjects All patients with cervical carcinoma who were diagnosed and treated in our institute from January 1, 1994 to December 31, 1998. Methods All medical records and pathological reports were reviewed. The patients who lost to follow up were contacted by telephone, mail, or computerized death data from local registration sector at BMA. Results Five hundred and seventy three patients were studied. SCC, the most common histologic type, was found in 79.23%. ACA including adenosquamous cell carcinoma and other subtypes consisted of 20.77%. The mean age in ACA group was 47.85 + 10.99 years which was significantly lower than 51.15 + 11.87 years of SCC group (p=0.006). Most patients (65.9%) with SCC had tumor grade II but patients with ACA were commonly found in grade III(42.0%). Regarding clinical presentation, ACA was found at earlier stages than SCC (p 0.05).(7) In this study, we aim to determine the survival rate of ACA of the uterine cervix in comparison with SCC in our institute.

Materials and Methods All medical records and pathological reports of newly diagnosed cervical cancer patients who were treated in BMA Medical College and Vajira Hospital between 1994 - 1999 were reviewed. All patients were clinically staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging(8) and treated with the same modalities for SCC and ACA. In stage IB – IIA, treatment was mainly surgery or surgery with adjuvant radiation. In stage IIB or more advanced disease, most patients received

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radiation alone and few recieved concurrent chemoradiation. After treatment, all patients were scheduled for a revisit every three months for two years, every six months for three years, and every year afterward. Before the end of our study (March 31, 2002), patients who lost to follow up were contacted by telephone or by mail at least twice. We also tried to find whether these patients were dead from the computerized data at the registry section of local administration with permission of the district registrar. The data was analysed by using SPSS program version 9.0. Descriptive statistics were used for demographic baseline data and summarized as mean with standard deviation (SD) or median with range. Continuous variables were examined for normal distribution (Kolmogorov-Smirnov test) before using parametric statistics. Differences between continuous variables were evaluated with unpaired t-test for variables that were normally distributed and the Mann-Whitney U test for variables that were not normally distributed. Categorical variables were evaluated with Chi-squared test or Fisher’s exact test as appropriate. Survival curves were obtained by the Kaplan- Meier method. Differences in survival rates between groups were compared using the Mantel-Haenszel log rank test. The p-value of 0.05 and less were considered as statistical significance.

Results During the study period (January 1, 1994 to December 31, 1999), there were 573 new cases of cervical cancer who had not received any kind of treatment before coming to our institute. Four hundred and fifty four cases were SCC (79.23%) while 109 cases (19.02%) were ACA, 9cases (1.57%) were adenosquamous cell carcinoma and 1 case (0.18%) was clear cell carcinoma. In this study, we

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compared SCC with ACA (including adenosquamouscell carcinoma and clear cell). The

characteristics of these patients are listed in Table 1

Table 1. Characteristics of cervical cancer patients Characteristics

Squamous cell carcinoma (total n = 454) n = 454 51.15 + 11.87 n = 319 12 (3.8%) 157 (49.2%) 150 (47.0%) n = 454 69 (15.2%) 142 (31.3%) 196 (43.2%) 47 (10.3%) n = 409 179 (43.8%) 230 (56.2%) n = 454 40.98 + 17.68 n = 454 111 (24.4%) 299 (65.9%) 13 (2.9%) 1 (0.2%) 30 (6.6%)

Adenocarcinoma p (total n = 119) Age ( years ) n = 119 (mean + S.D.) 47.85 + 10.99 0.006* ** Parity n = 78 - nulliparity 6 (7.7%) 0.137† - 1-3 42 (53.8%) ->4 30 (38.5%) Stage n = 119 - stage I 26 (21.9%)