Survival in human papillomavirus and non-human papillomavirus-associated invasive endocervical adenocarcinoma: outcomes in a large, integrated healthcare system.

Abstract

Objectives: To ascertain outcome differences between human papillomavirus (HPV)-associated and non-HPV-associated endocervical adenocarcinoma within an integrated healthcare system.

Methods: This retrospective cohort study examined patients aged 18 to 90 years diagnosed with invasive endocervical adenocarcinoma from 2011 to 2017 using our institution's cancer registry. Demographic and clinical variables were abstracted from records. Five-year overall survival and progression-free survival were assessed for HPV-associated and non-HPV-associated cancer types. Chi-square and Fisher exact tests compared categorical, while Wilcoxon rank-sum tests analyzed continuous variables. Kaplan-Meier curves compared 5-year survival between groups.

Results: Among 144 patients, 34 (24%) had non-HPV-associated and 110 (76%) had HPV-associated cancers. Patients with non-HPV-associated endocervical adenocarcinoma had worse 5-year progression-free survival (72% vs 88%, p = .03) and overall survival (75% vs 92%, p < .01). Non-HPV-associated endocervical adenocarcinoma was more likely to be diagnosed at older ages (median 54 years vs 42 years, p < .01). A high percentage of early-stage diagnoses were observed (74% of non-HPV-associated endocervical adenocarcinoma and 86% of HPV-associated endocervical adenocarcinoma were diagnosed at stage I).

Conclusions: While 5-year survival was worse in non-HPV-associated endocervical adenocarcinoma, differences were less pronounced than previously reported, potentially due to the high percentage of early-stage diagnoses, suggesting that stage remains the most important prognostic factor.