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Gastric-type adenocarcinoma of the cervix: Clinical outcomes and genomic drivers

Published:October 15, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.10.003

      Highlights

      • Most patients with gastric-type endocervical adenocarcinoma (GEA) are diagnosed with stage II or higher disease.
      • Clinical outcomes among patients with GEA are poor.
      • GEA is associated with higher rates of ovarian metastasis than other cervical cancers.
      • The majority of patients who experienced recurrence were initially treated with chemo-radiation.
      • Next generation sequencing is recommended to identify targetable alterations such as ERBB2 amplifications.

      Abstract

      Objectives

      Gastric-type endocervical adenocarcinoma (GEA) is a rare form of cervical cancer not associated with human papilloma virus (HPV) infection. We summarize our experience with GEA at a large cancer center.

      Methods

      Clinical and demographic information on all patients diagnosed with GEA between June 1, 2002 and July 1, 2019 was obtained retrospectively from clinical charts. Kaplan-Meier survival analysis was performed to describe progression-free survival (PFS) and overall survival (OS). Tumors from a subset of patients underwent next generation sequencing (NGS) analysis.

      Results

      A total of 70 women with GEA were identified, including 43 who received initial treatment at our institution: of these 4 (9%) underwent surgery alone, 15 (35%) underwent surgery followed by adjuvant therapy, 10 (23%) were treated with definitive concurrent chemoradiation (CCRT), 7 (16%) with chemotherapy alone, and 3 (7%) with neoadjuvant CCRT and hysterectomy with or without chemotherapy. One-third (n = 14) of patients experienced disease progression, of whom 86% (n = 12) had prior CCRT. The median PFS and OS for patients with stage I GEA were 107 months (95% CI 14.8–199.2 months) and 111 months (95% CI 17–205.1 months) respectively, compared to 17 months (95% CI 5.6–28.4 months) and 33 months (95% CI 28.2–37.8 months) for patients with stages II–IV, respectively. On NGS, 4 patients (14%) had ERBB2 alterations, including 2 patients who received trastuzumab.

      Conclusions

      GEA is an aggressive form of cervical cancer with poor PFS and OS when diagnosed at stage II or later. Further investigation is needed to identify the optimal management approach for this rare subtype.

      Keywords

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