Discussion On Optimal Treatments Of Cervical Adenocarcinoma

Objective: To compare the prognosis of patients with cervical adenocarcinoma treated by concurrent chemoradiotherapy(CCRT)and radical surgery,and establish a nomogram predicting the overall survival(OS)rate of patients with cervical adenocarcinoma after initial treatment.Methods: The study is a retrospective study based on registered population of SEER database.3256 patients with cervical adenocarcinoma were included as the training cohort,and 302 patients with cervical adenocarcinoma from the Cancer Hospital of China Medical University were included as the validating cohort.The CCRT group was defined as receiving comprehensive treatment based on CCRT after initial diagnosis,and the surgery group was defined as receiving comprehensive treatment based on radical surgery which may be combined with neoadjuvant or postoperative supplementary treatment.Cox regression was used to evaluate factors affecting the OS of patients with cervical adenocarcinoma,and a nomogram was developed to predict the OS of patients with cervical adenocarcinoma.Results: In the training cohort,689(21.16%)patients were in the CCRT group and 2567(78.84%)patients were in the surgery group.Log-rank test showed that age,marital status,tumor size,tissue differentiation,FIGO stage,and treatment were associated with the OS of patients with cervical adenocarcinoma(P<0.05).The OS of the surgery group was significantly longer than that of the CCRT group(P<0.05)in the whole population and in subgroups of IB,IIB,IIIC and IVB stage,while for the patients with IA,IIA,IIIA,IIIB and IVA stage,the OS of two groups showed no significant difference.For patients with IIIC stage,the OS of patients with stage T1 and T2 in the surgery group was significantly longer than that in the CCRT group(P=0.004,P<0.001,respectively),while there was no statistically significant difference between OS of the two groups in T3 stage(P=0.075).Multivariate analysis showed that senility,lower differentiation and advanced stage were independent risk factors affecting the OS of patients with cervical adenocarcinoma,while surgery was a protective factor(HR 0.542,95%CI 0.448-0.655,P<0.001).Based on the four factors,a nomogram was drawn to predict the OS rate of patients with cervical adenocarcinoma in the following 3 and 5 years after initial treatment.External validation showed the consistency index(C-index)of nomogram was0.777,and the calibration curve of nomogram showed good accuracy.Conclusion: Patients with cervical adenocarcinoma,especially with IB,IIB,IIIC(T1,T2)and IVB stage,could benefit from comprehensive treatment based on radical surgery rather than CCRT.The nomogram involved four factors including age,tissue differentiation,FIGO stage and treatment,and had good survival prediction efficacy for patients with cervical adenocarcinoma after standard initial treatment.