Survival comparison analysis between cervical squamous cell carcinoma and adenocarcinoma with a special focus on the HPV status

BACKGROUND: Our study examines impact of HPV status and patient-specific characteristics on recurrence-free survival (RFS) and overall survival (OS) for SCC and ECA. METHODS: 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. RESULTS: 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. CONCLUSION: Tumor type and HPV status play significant role in determining survival outcomes in CC.