Non Squamous Histology in Cervical Cancer: Prognostic Insights from Institutional Study

Abstract

Background: Non-squamous histologies in carcinoma cervix, including adenocarcinoma (AC) and adenosquamous carcinoma (ASC), represent a clinically and biologically distinct subgroup with reportedly inferior outcomes compared to squamous cell carcinoma (SCC). Limited data exist regarding their treatment outcomes in the Indian population. This study aimed to evaluate the clinical profile, treatment response, patterns of failure, and survival outcomes in patients with non-squamous carcinoma of the cervix treated at our tertiary care center.

Methods: This retrospective study included patients with histologically confirmed non-squamous cervical cancer treated with definitive or adjuvant radiotherapy between January 2020 and December 2024. Clinical characteristic, pathological, and treatment details were collected. Disease-free survival (DFS), overall survival (OS), and patterns of failure were analyzed. Statistical analysis was performed using the unpaired t-test.

Results: A total of 34 patients were included, with a mean age of 48.6 years. Adenocarcinoma was the most common histology (21 patients ,61.8%), followed by adenosquamous carcinoma in 7 (20.6%) and other rare subtypes (6 patients,17.6%). The most common stage at the presentation was FIGO IIB. Twelve patients (35.3%) underwent primary surgery followed by adjuvant therapy, and 22 (64.7%) received definitive concurrent chemoradiation (CCRT).

After a median follow-up of 28 months, the mean DFS and OS were 27.2 and 29 months, respectively. Patients undergoing surgery had numerically higher DFS and OS (30.4 and 34.3 months) compared to those receiving definitive CCRT (25.5 and 26.1 months), though not statistically significant (p = 0.63 for DFS; p = 0.34 for OS). Failure patterns showed slightly higher recurrence in the surgery group (5 patients, 41.6%) compared to the CCRT group (3 patients, 13.6%).

Conclusion: Non-squamous cervical cancers exhibit relatively poorer outcomes and distinct failure patterns. While primary surgery may offer a survival advantage in early-stage disease, CCRT remains the mainstay for advanced stages. Tailored treatment approaches and molecular profiling are warranted to optimize outcomes in this high-risk subgroup.

Key words: Cervical cancer, adenocarcinoma, adenosquamous carcinoma, chemoradiation, surgery, survival, recurrence pattern, non-squamous histology.