Clinicopathological characteristics and prognosis of cervical adenocarcinoma across diverse histological subtypes

OBJECTIVE: To investigate the clinical features and prognostic implications of different subtypes of cervical adenocarcinoma. METHODS: We examined 13,353 adenocarcinoma (AC) cases from the SEER database to identify distinct clinical characteristics and prognostic factors among various histological subtypes. Using the WHO classification and International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes, we categorized patients and assessed overall survival (OS) and cancer-specific survival (CSS) via Kaplan-Meier and Cox regression analyses. A nomogram was constructed to predict patient survival across subtypes. RESULTS: Patients with non-usual type show a significantly poorer prognosis. Our analysis revealed that serous carcinoma patients had the most adverse outcomes (OS: hazard ratio (HR) = 2.69, 95% confidence interval (CI): 2.23-3.23, P < 0.001; CSS: HR = 1.78, 95% CI: 1.34-2.36, P < 0.001), while villous adenocarcinoma patients had the most favorable (OS: HR = 0.43, 95% CI: 0.29-0.65, P < 0.001; CSS: HR = 0.32, 95% CI: 0.17-0.60, P < 0.001), compared to the usual type. Multivariable Cox regression identified age, marital status, race, tumor grade, FIGO stage, and treatment as independent prognostic factors. In patients with serous carcinoma, advanced FIGO stage was a risk factor (stage IV vs stage I: HR = 4.06, 95% CI: 1.35-12.22, P = 0.013), and surgery was a protective factor (HR = 0.22, 95% CI: 0.10-0.49, P < 0.001). We also created a prognostic model incorporating diverse histological subtypes, internally validated for high predictive accuracy and discrimination via the receiver operating characteristic (ROC) curve and calibration plots. CONCLUSION: Clinical characteristics and prognostic features in cervical adenocarcinoma vary significantly by histological subtype, with serous carcinoma being associated with the worst outcomes.