S. Jhavar1, C. Claunch2, D. A. Hamstra2, T. R. Hall3, C. Hoppenot3, M. S. Ludwig2, A. Echeverria2, and S. Sharma2; 1Baylor College of Medicine, Houston, TX, 2Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, 3Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
Purpose/Objective(s): Clear cell adenocarcinoma of the cervix (ClCCx), a rare histopathological variant, is often managed akin to squamous cell carcinoma (SCC). Yet, gaps persist in understanding patient presentations and optimal locoregional treatments (LRT). Our study aims to delve into patient, tumor, and treatment-related characteristics of ClCCx and assess the correlation between LRT and overall survival (OS). Materials/
Methods: Leveraging the 2019 National Cancer Database (NCDB) cervical cancer dataset, cases with ClCCx were identified. Patient demographics, tumor specifics, and treatment details were extracted. Univariate (UVA) and multivariate Cox regressions (MVA) were utilized to scrutinize OS, and the comparative effectiveness of LRT was examined through 1:1 propensity score matching for significant factors. Results: In 1417 patients with ClCCx, mean age was 59.16 (range: 18-90). Age distribution included 141 (9.9%) =35 years old and 868 (61.3%) >55 years; stages were I (43.5%), II (16.8%), III (17.1%), and IV (15.9%); poorly/undifferentiated grade tumors 45.8%, and tumor sizes: =4 cm (30.2%), >4-8 cm (19.8%), and >8 cm (4.8%). Among 976 patients with non-metastatic disease and documented LRT, groups included chemoradiation 26.7%, surgery-only 30%, surgery + radiation 12.6%, and surgery + radiation + chemotherapy (trimodality) 30.6%. Unadjusted mean OS was 82.5, 154.6, 125.4, and 133.5 months, respectively. UVA identified significant prognostic factors for OS, including age, race, insurance status, household income, education, Charlson-Deyo (CD) score, stage, and type of locoregional treatment (p<0.001 and p<0.005 for household income). MVA showed age 18-25 (HR 0.153; CI 0.037-0.642) with age >55 as reference, chemoradiation (reference), surgery-only (0.676; 0.459-0.995), trimodality (0.474; 0354-0.635), no insurance (reference), Medicare (2.052; 1.162-3.625), other government insurance (3.955; 1.389-11.259), CD scores 0 (reference), 1 (1.669; 1.256-2.217), 2 (2.316; 1.377-3.894), and 3 (2.407; 1.193-4.857), and stages I (reference), II (2.430; 1.650-3.580), III (3.794; 2.626-5.481), IV (8.255; 5.236-12.795) were significant factors. LRT groups exhibited significant differences in stage, age, CD score. After matching for age, stage, and CD score, trimodality demonstrated better median OS compared to chemoradiation (168.97 vs 48.2 months, p <0.001). Conclusion: Survival trends in ClCCx reveal social determinants impact outcomes. LRT pattern in ClCCx mirrors SCC. However, unlike SCC, trimodality therapy (surgery, radiation, chemotherapy) shows superior survival for locoregionally advanced disease. With emerging evidence of adenocarcinomas steep dose response to radiation and increased utilization of IMRT reducing morbidity, reconsidering trimodality therapy in this population is crucial.
