Clinical outcomes of Human papillomavirus associated (HPVA) and non HPVA cervical adenocarcinoma: a minimum 3-year follow-up analysis

Abstract

Abstract Objective The International Standard and Classification of Cervical Adenocarcinoma (IECC) classifies cervical adenocarcinoma into HPV related (HPVA) and non HPVA (NHPVA) types based on morphology. However, the differences and prognostic factors between the two types of cervical adenocarcinoma are still unclear. This study aims to evaluate the clinical pathological characteristics and prognostic factors of two groups at least 3 years of follow-up. Methods We included 147 patients diagnosed with cervical adenocarcinoma between 2012 and 2020. Using Wilcoxon rank sum test, χ² test or Fisher's exact test to compare clinical case characteristics between HPVA group and NHPVA group. Using Kaplan Meier and Cox regression to analysis the survival differences and prognostic factors between HPVA and NHPVA. Results The average age and lesion size of the NHPVA groups was older and larger than HPVA group (P = 0.0111, 0.038, respectively). Compared with the HPVA group, NHPVA has a later stage and is more prone to LVI, LNM and distant metastasis (P = 0.001,0.022,0.001 and 0.016 respectively). Compared with HPVA, NHPVA had poorer overall survival (OS) and progression free survival (PFS) (p < 0.001, p < 0001, respectively). Surgery can improve overall survival compared to radiotherapy and chemotherapy in both the HPVA and NHPVA groups (P = 0.028, 0.017, respectively). FIGO 2018 stage is the only factor that affects prognosis both in HPVA and NHPVA (P = 0.041 and 0.039 respectively). Conclusions Compared with HPVA, NHPVA has a worse prognosis. Whether for HPVA or NHPVA, surgery is a protective factor and the FIGO 2018 stage is the main factor affecting prognosis.