Prognostic impact of primary surgery in human papillomavirus‐independent, advanced or metastatic endocervical adenocarcinoma: A bi‐institutional retrospective study
Abstract
Objective
To evaluate the prognostic impact of primary surgery on patients with HPV‐independent, advanced or metastatic endocervical adenocarcinoma (EAC) who typically exhibit poor survival outcomes and resistance to conventional therapies such as chemoradiotherapy.
Methods
A bi‐institutional retrospective study was conducted at Samsung Medical Center and Taiwan National University Hospital. Between 2001 and 2023, 92 patients with HPV‐independent advanced or metastatic EAC were included. Patients were divided into two groups: 54 (58.7%) underwent primary surgery and 38 (41.3%) received non‐surgical treatments, including definitive radiotherapy or palliative chemotherapy. Kaplan–Meier analysis was used to compare progression‐free survival (PFS) and overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors.
Results
The surgery group demonstrated significantly improved outcomes, with a median PFS of 19.2 months, compared with 10.0 months in the non‐surgery group (P < 0.001). Median OS was not reached in the surgery group, whereas it was 24.1 months in the non‐surgery group (P = 0.002). Multivariate analysis showed that non‐surgical treatment was an independent predictor of poor PFS (hazard ratio [HR] 2.25; 95% confidence interval [CI] 1.18–4.29; P = 0.013) and OS (HR 3.25; 95% CI 1.37–7.73; P = 0.008). Additionally, the recurrence rate was significantly lower in the surgery group (55.6%) than in the non‐surgery group (84.2%; P = 0.006).
Conclusion
Primary surgery significantly improves survival outcomes in patients with HPV‐independent advanced or metastatic EAC. These findings suggest that surgery should be considered as part of a multimodal treatment strategy for this aggressive subtype, highlighting the need for individualized therapeutic approaches beyond standard chemoradiotherapy protocols.