Survival comparison analysis between cervical squamous cell carcinoma and adenocarcinoma with a special focus on the HPV status
Our study examines impact of HPV status and patient-specific characteristics on recurrence-free survival (RFS) and overall survival (OS) for SCC and ECA. This multi-continental retrospective study analyzed clinicopathologic data of 634 patients with microscopically confirmed cervical cancer (CC; only SCC and ECA) across Asia, Europe, and North America. HPV status was determined using PCR or HPV in situ hybridization (ISH) for both HR-HPV (SCC and ECA) and LR-HPV (SCC), using same platform. Descriptive analysis and Cox regression models were produced. Out of total 634 patients, 533 (84.1%) were HPVA and 101 (15.9%) were HPVI. 65% had SCC morphology (88.1%: HPVA; 11.9%: HPVI) and 35% had ECA differentiation (76.6%: HPVA; 23.4%: HPVI). Compared to ECA, patients with SCC were older (median age: 51 vs. 45 years old; p < 0.001), had higher HPVA status (88.1% vs. 76.6%; p < 0.001), and a higher rate of lymph-vascular invasion (LVI; 64.8% vs. 56.8%; p = 0.004). However, patients with ECA had a higher rate of metastases to pelvic organs (13.5% vs. 2.4%; p < 0.001). In univariable analysis, HPV status, tumor type, higher FIGO stage, older age, LVI positive, lymph node metastasis (LNM), and adjuvant treatment were all associated with impaired RFS and OS (all p ≤ 0.007). In multivariable analysis, LVI, HPV status, institution, and tumor type remained significant for RFS, while age at diagnosis, FIGO stage, LVI, and tumor type remained significant for OS. Tumor type and HPV status play significant role in determining survival outcomes in CC.