Poor Treatment Outcomes of Locally Advanced Cervical Adenocarcinoma of Human Papilloma Virus Independent Type, Represented by Gastric Type Adenocarcinoma: A Multi-Center Retrospective Study (Sankai Gynecology Study Group)

SIMPLE SUMMARY: Cervical adenocarcinomas have been divided into human papilloma virus-associated (HPVa) and -independent (HPVi) tumors in the updated pathological classification issued by the World Health Organization in 2020. However, few studies have investigated the impact of this new classification on the treatment outcomes and prognosis of locally advanced cervical adenocarcinoma. We investigated the treatment outcomes of 103 and 48 patients with locally advanced (stages IB3–IIIC1) HPVa and HPVi cervical adenocarcinomas, respectively. Most patients underwent radical hysterectomy with or without adjuvant therapy for both tumor types. The overall survival time and survival to progression or death were significantly shorter in the HPVi group than in the HPVa group. In particular, patients with parametrial invasion had highly significant differences in survival. Only five patients with HPVi carcinomas received definitive radiotherapy, and all demonstrated a treatment response. HPVi tumors showed poor outcomes with the current treatment strategy. ABSTRACT: The revised World Health Organization classification of cervical cancer divides adenocarcinomas into human papillomavirus-associated (HPVa) and -independent (HPVi) types; the HPVi type is represented by the gastric type. The treatment outcomes of locally advanced adenocarcinoma (LaAC), based on this classification, are understudied. We investigated the outcomes of patients with HPVa and HPVi LaACs. Data for all consecutive patients with stage IB3 to IIIC1 adenocarcinoma who received treatment at 12 institutions throughout Japan between 2004 and 2009 were retrieved to analyze progression-free and overall survival. Central pathological review classified 103 and 48 patients as having HPVa and HPVi tumors, respectively. Usual- (84%) and gastric- (90%) type adenocarcinomas were the most frequent subtypes. Surgery was the primary treatment strategy for most patients. Progression-free and overall survival of patients with HPVi were worse than those of patients with HPVa (p = 0.009 and 0.032, respectively). Subgroup analysis by stage showed that progression-free survival was significantly different for stage IIB. The current surgical treatment strategy for LaACs is less effective for HPVi tumors than for HPVa tumors, especially those in stage IIB.