Impact of Tumour Histology on Survival in Advanced Cervical Carcinoma: an NRG Oncology/Gynaecologic Oncology Group Study

Overview

Journal Br J Cancer

Specialty Oncology

Date 2017 Nov 29

PMID 29182608

Citations 10

Authors

Leigh G Seamon

James J Java

Bradley J Monk

Richard T Penson

Jubilee Brown

Robert S Mannel

Anna Oaknin

Mario M Leitao

Eric L Eisenhauer

Harry J Long

Shu Y Liao

Krishnansu S Tewari

Affiliations

Soon will be listed here.

Abstract

Background: Based primarily on studies concerning early-stage tumours (treated surgically), and locally advanced disease (treated with chemoradiation), the prognosis for women with adenocarcinoma (AC) or adenosquamous (AS) carcinoma has been reported to be poorer than those with squamous cell carcinoma (SCCA) of the cervix. It is unclear whether differences in prognosis also persist in the setting of recurrent or metastatic disease treated using chemotherapy doublets with or without bevacizumab.

Methods: Cases were pooled from three Gynaecologic Oncology Group randomised phase III trials of chemotherapy doublets. Pearson's test was used to evaluate response rate (RR) of AC/AS vs SCCA, Kaplan-Meier method to estimate progression-free survival (PFS) and overall survival (OS), and Cox proportional hazards model to estimate the impact of histology on PFS and OS.

Results: Of 781 evaluable patients, 77% (N=599) had SCCA and 23% (N=182) AC/AS. There were no significant differences in RRs between histologic subgroups. The adjusted hazard ratio (HR) for death for SCCA vs AC/AS was 1.13 (95% CI 0.93, 1.38 P=0.23). When comparing SC/AS (N=661, 85%) to AC alone (N=120, 15%), the adjusted HR for death was 1.23 (95% CI 0.97, 1.57, P=0.09).

Conclusions: AC/AS and SCCA have similar survival in recurrent or metastatic cervical carcinoma when treated with chemotherapy doublets.

Citing Articles

Treatment advances across the cervical cancer spectrum.

Francoeur A, Monk B, Tewari K Nat Rev Clin Oncol. 2025; 22(3):182-199.

PMID: 39753753 DOI: 10.1038/s41571-024-00977-w.

Addition of Bevacizumab to Chemotherapy and Its Impact on Clinical Efficacy in Cervical Cancer: A Systematic Review and Meta-Analysis.

Shahzad A, Ur Rehman A, Naz T, Rasool M, Saeed A, Rasheed S Pharmacy (Basel). 2024; 12(6).

PMID: 39728845 PMC: 11677453. DOI: 10.3390/pharmacy12060180.

Competitive Risk Model Nomogram to Predict Prognosis in Patients Aged Over 65 Years with nonmetastatic Cervical Cancer: A SEER Population-Based Study.

Jiao S, Guo L, Da F, Gao Q, Ren Z, Wang J Technol Cancer Res Treat. 2023; 22:15330338231164191.

PMID: 37078156 PMC: 10126705. DOI: 10.1177/15330338231164191.

Final survival analysis of topotecan and paclitaxel for first-line treatment of advanced cervical cancer: An NRG oncology randomized study.

Tewari K, Sill M, Birrer M, Penson R, Huang H, Moore D Gynecol Oncol. 2023; 171:141-150.

PMID: 36898292 PMC: 10286827. DOI: 10.1016/j.ygyno.2023.01.010.

Immune checkpoint blockade for locally advanced or recurrent/metastatic cervical cancer: An update on clinical data.

Song Z, Zou K, Zou L Front Oncol. 2023; 12:1045481.

PMID: 36644634 PMC: 9832370. DOI: 10.3389/fonc.2022.1045481.

References

Katanyoo K, Sanguanrungsirikul S, Manusirivithaya S . Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer. Gynecol Oncol. 2012; 125(2):292-6. DOI: 10.1016/j.ygyno.2012.01.034. View

Gien L, Beauchemin M, Thomas G . Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2009; 116(1):140-6. DOI: 10.1016/j.ygyno.2009.09.040. View

Monk B, Sill M, Burger R, Gray H, Buekers T, Roman L . Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2009; 27(7):1069-74. PMC: 2667811. DOI: 10.1200/JCO.2008.18.9043. View

Penson R, Huang H, Wenzel L, Monk B, Stockman S, Long 3rd H . Bevacizumab for advanced cervical cancer: patient-reported outcomes of a randomised, phase 3 trial (NRG Oncology-Gynecologic Oncology Group protocol 240). Lancet Oncol. 2015; 16(3):301-11. PMC: 4479218. DOI: 10.1016/S1470-2045(15)70004-5. View

Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W . Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004; 350(23):2335-42. DOI: 10.1056/NEJMoa032691. View

Rose P, Java J, Whitney C, Stehman F, Lanciano R, Thomas G . Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in gynecologic oncology group trials of cisplatin-based chemoradiation. Gynecol Oncol. 2014; 135(2):208-12. PMC: 4557698. DOI: 10.1016/j.ygyno.2014.08.018. View

Long 3rd H, Bundy B, Grendys Jr E, Benda J, McMeekin D, Sorosky J . Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2005; 23(21):4626-33. DOI: 10.1200/JCO.2005.10.021. View

Fujiwara K, Monk B, Devouassoux-Shisheboran M . Adenocarcinoma of the uterine cervix: why is it different?. Curr Oncol Rep. 2014; 16(12):416. DOI: 10.1007/s11912-014-0416-y. View

Siegel R, Miller K, Jemal A . Cancer Statistics, 2017. CA Cancer J Clin. 2017; 67(1):7-30. DOI: 10.3322/caac.21387. View

10.

Tewari K, Sill M, Long 3rd H, Penson R, Huang H, Ramondetta L . Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014; 370(8):734-43. PMC: 4010094. DOI: 10.1056/NEJMoa1309748. View

11.

Ojesina A, Lichtenstein L, Freeman S, Pedamallu C, Imaz-Rosshandler I, Pugh T . Landscape of genomic alterations in cervical carcinomas. Nature. 2014; 506(7488):371-5. PMC: 4161954. DOI: 10.1038/nature12881. View

12.

Hoskins P, Swenerton K, Pike J, Lim P, Aquino-Parsons C, Wong F . Small-cell carcinoma of the cervix: fourteen years of experience at a single institution using a combined-modality regimen of involved-field irradiation and platinum-based combination chemotherapy. J Clin Oncol. 2003; 21(18):3495-501. DOI: 10.1200/JCO.2003.01.501. View

13.

Eskander R, Tewari K . Targeting angiogenesis in advanced cervical cancer. Ther Adv Med Oncol. 2014; 6(6):280-92. PMC: 4206649. DOI: 10.1177/1758834014543794. View

14.

Berrington de Gonzalez A, Sweetland S, Green J . Comparison of risk factors for squamous cell and adenocarcinomas of the cervix: a meta-analysis. Br J Cancer. 2004; 90(9):1787-91. PMC: 2409738. DOI: 10.1038/sj.bjc.6601764. View

15.

Young R, Clement P . Endocervical adenocarcinoma and its variants: their morphology and differential diagnosis. Histopathology. 2002; 41(3):185-207. DOI: 10.1046/j.1365-2559.2002.01462.x. View

16.

Tewari K, Sill M, Monk B, Penson R, Long 3rd H, Poveda A . Prospective Validation of Pooled Prognostic Factors in Women with Advanced Cervical Cancer Treated with Chemotherapy with/without Bevacizumab: NRG Oncology/GOG Study. Clin Cancer Res. 2015; 21(24):5480-7. PMC: 4896296. DOI: 10.1158/1078-0432.CCR-15-1346. View

17.

Moore D, Tian C, Monk B, Long H, Omura G, Bloss J . Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol. 2009; 116(1):44-9. PMC: 4470610. DOI: 10.1016/j.ygyno.2009.09.006. View

18.

Silcocks P, Murphy M . Squamous and adenocarcinoma of the uterine cervix: a comparison using routine data. Br J Cancer. 1987; 55(3):321-5. PMC: 2001756. DOI: 10.1038/bjc.1987.63. View

19.

Monk B, Sill M, McMeekin D, Cohn D, Ramondetta L, Boardman C . Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009; 27(28):4649-55. PMC: 2754911. DOI: 10.1200/JCO.2009.21.8909. View

20.

Green J, Berrington de Gonzalez A, Sweetland S, Beral V, Chilvers C, Crossley B . Risk factors for adenocarcinoma and squamous cell carcinoma of the cervix in women aged 20-44 years: the UK National Case-Control Study of Cervical Cancer. Br J Cancer. 2003; 89(11):2078-86. PMC: 2376844. DOI: 10.1038/sj.bjc.6601296. View