[Cervical adenocarcinomas: diagnostic, prognostic and therapeutic aspects in a 49 case-control study]. / Aspects diagnostiques, pronostiques et thérapeutiques des adénocarcinomes du col utérin: à propos d'une série de 49 cas.

ABSTRACT

OBJECTIVES: The aim of this study was to search for potential diagnostic, therapeutic and prognosis differences between a series of 49 adenocarcinomas of the cervix and a matched series of epidermoid carcinomas. METHODS: Forty-nine adenocarcinomas were treated between 1978 and 1992 and retrospectively compared to a series of 98 paired epidermoid carcinomas. RESULTS: The adenocarcinoma incidence is 5.4%. There was no significant difference for age distribution, parity, or hormonal status. There was also no significant difference for clinical features. Stage I appeared more frequently in the adenocarcinoma group (stage I 69.4%, stage II 14.3%, stage III 14.3%, stage IV 2%). Stage I are also more frequently found in the adenocarcinoma group (69.4% versus 42. 9%, p< 0,05). Combined radio-surgical treatment was proposed more often for the adenocarcinoma group (respectively radio-surgery combination 73%, radiotherapy alone 18%, surgery 9%); in the epidermoid carcinoma group, combined radio-surgical treatment and radiotherapy were the usual treatment (46%); surgery alone appeared in third rank place (8%). Adenocarcinoma pelvic recurrences appeared more frequently (28.6% for adenocarcinoma group versus 13.3% for epidermoid group p< 0.05), while distant recurrence was the same (12. 2% for adenocarcinoma group versus 11.2% for epidermoid group, p< 0. 05). Five years overall survival rate was worse for the adenocarcinoma group (52% versus 63.7%, p< 0.05) but the difference was not significant for the disease free survival rate. Only for stage Ib, there are also more pelvic recurrences (35.4% versus 13.1%, p< 0.05), more distant recurrences (9.6% versus 2.6%, p< 0.05), and lower overall survival for adenocarcinomas (58.7% versus 88.5%, p< 0. 01). CONCLUSION: The incidence of adenocarcinomas is slightly increasing (absolute value in our experience) and the low stages seem to be more frequent in our experience probably by staging inaccuracy. Adenocarcinoma prognosis seems to be worse because of its poor radio-sensitivity. It seems necessary to optimize clinical staging and therapeutic protocols excluding radiotherapeutic approach, including surgical purposes or radio-surgical associations if unfavorable histological features or tumoral enlargement (T> 3 cm) are found.