Comparison of the clinical outcomes of patients with stage IA–IIA2 cervical adenocarcinoma and squamous cell carcinoma after radical hysterectomy: A propensity score‐matched real‐world analysis

Abstract Objective To compare the pathological findings and survival outcomes of patients with 2009 FIGO stage IA–IIA2 cervical cancer between groups with adenocarcinoma (ADC) and squamous cell carcinoma (SCC) using the Chinese Cervical Cancer Clinical (FOUR‐C) study database. Methods Patients from 2004 to 2018 with cervical ADC and SCC who underwent radical hysterectomy were identified through the FOUR‐C database. Propensity score matching (PSM) was conducted to balance baseline clinicopathological characteristics. The Kaplan–Meier method and Cox regression analysis were used to evaluate the prognostic effect of ADC on the 5‐year overall survival (OS). Results We identified 1611 (9.8%) patients with ADC and 14 894 (90.2%) patients with SCC. Compared with SCC, ADC was significantly associated with an increased risk of death (odds ratio [OR] 1.40, 95% CI 1.12–1.74) and disease progression (OR 1.34, 95% CI 1.14–1.57). ADC had a greater propensity for lymph node metastasis, uterine corpus invasion, perineural invasion, and ovarian metastases than SCC ( P < 0.05). After 1:2 PSM, significant differences were still observed between these two histology subtypes (OS: OR 1.43, 95% CI 1.10–1.86; DFS: OR 1.45, 95% CI 1.19–1.76). The subgroup analysis further showed a worse prognosis for patients with ADC than for patients with SCC among patients with any of the high‐ or intermediate‐ risk factors (OR 1.60, 95% CI 1.21–2.12), but no significant differences were observed for the patients with no risk factors (OR 0.71, 95% CI 0.32–1.58). Conclusion ADC is an independent prognostic factor for shorter survival in surgically treated patients with cervical cancer presenting intermediate‐ or high‐risk factors but does not affect survival outcomes in patients without any risk factors.