Tremblay Elizabeth, Samouëlian Vanessa, Carmant Laurence, Auclair Marie-Hélène, Undurraga Manuela, Barkati Maroie, Rahimi Kurosh, Gougeon François, Péloquin Laurence, Cormier Béatrice
Division of Gynecologic Oncology, CHUM, Canada.
Université de Montréal, Canada.
Gynecol Oncol Rep. 2023 Oct 4;50:101282. doi: 10.1016/j.gore.2023.101282. eCollection 2023 Dec.
Gastric-type adenocarcinoma of the endocervix (GAS) is a rare form of human papillomavirus-independent cervical cancer commonly described as an insidious disease bearing a poor prognosis. Based on scarce data, uncertainty persists pertaining to its oncologic management.
All cases of well-differentiated GAS treated at our institution from 2010 to 2021 were reviewed. Clinical characteristics, diagnostic tests results and oncologic outcomes were recorded and analyzed. Kaplan-Meier curves and log rank test were performed to compare survival curves between patients with tumors confined to the cervix (group 1: up to stage IB3) versus locally advanced or metastatic (group 2: stages II to IV).
Cervical cytologies and biopsies yielded low detection rates (38 and 42% respectively) leading to 87% of patients with locally advanced or metastatic disease at diagnosis. Median overall survival (OS) was 40.0 ± 15.9 months with a clear dichotomy in survival when comparing patients with disease confined to the cervix to those with higher stages (respectively 59.0 vs 12.0 months, p = 0.047). None of the 5 patients initially managed with concurrent chemoradiotherapy (CCRT) responded to treatment but fortunately 3 of the latter achieved remission after surgery.
Well-differentiated GAS did not show favorable response to chemotherapy and radiation. Surgical resection seems to be a cornerstone in the management of this disease, as all patients who achieved remission were treated with surgery, either upfront or after suboptimal response to CCRT. We suggest considering aggressive upfront surgery when feasible. If CCRT is selected to avoid upfront exenterative procedures, rapid evaluation of tumor response is recommended.
宫颈胃型腺癌（GAS）是一种罕见的与人乳头瘤病毒无关的宫颈癌，通常被描述为一种隐匿性疾病，预后较差。基于稀缺的数据，其肿瘤治疗管理仍存在不确定性。
回顾了2010年至2021年在本机构接受治疗的所有高分化GAS病例。记录并分析临床特征、诊断检查结果和肿瘤学结局。采用Kaplan-Meier曲线和对数秩检验比较局限于宫颈的肿瘤患者（第1组：IB3期及以下）与局部晚期或转移性患者（第2组：II至IV期）的生存曲线。
宫颈细胞学检查和活检的检出率较低（分别为38%和42%），导致87%的患者在诊断时患有局部晚期或转移性疾病。中位总生存期（OS）为40.0±15.9个月，将疾病局限于宫颈的患者与更高分期的患者进行比较时，生存情况有明显差异（分别为59.0个月和12.0个月，p = 0.047）。最初接受同步放化疗（CCRT）的5例患者均对治疗无反应，但幸运的是，其中3例在手术后获得缓解。
高分化GAS对化疗和放疗无良好反应。手术切除似乎是该疾病治疗的基石，因为所有获得缓解的患者均接受了手术治疗，要么是初始手术，要么是在对CCRT反应欠佳后手术。我们建议在可行的情况下考虑积极的初始手术。如果选择CCRT以避免初始的脏器清除手术，则建议快速评估肿瘤反应。
