The Impact of Surgery and Survival Prediction on Patients with Locally Advanced Gastric-type Endocervical Adenocarcinoma: A Population-Based Cohort Study.

Abstract

This study aimed to examine the clinical characteristics of gastric-type endocervical adenocarcinoma (GEA-C) and the main factors affecting prognosis, and to investigate the effect of surgical treatment on the prognosis of patients with GEA-C. In this study, clinicopathologic data of GEA-C were collected from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019). Multivariate Cox regression analysis, Kaplan-Meier survival analysis, and the log-rank test were used to assess the effect of surgical interventions on different subgroups in the overall survival (OS) of patients with GEA-C. In the overall cohort, the surgical group demonstrated significantly better OS than the non-surgical group (79.6% vs 38.2%; p < 0.001). This survival advantage persisted after propensity score-matching (PSM) (79.6% vs 47.4%; p < 0.001). Among the patients with locally advanced disease, the OS rates were 64.6% versus 43.8% (p = 0.040) favoring surgery, with the disparity further accentuated after PSM (64.6% vs 12.5%; p < 0.001). Subgroup analyses confirmed sustained survival benefits with surgery across all strata, including age (≤50 years: 88.5% vs 30.8% [p < 0.001]; >50 years: 64.8% vs 42.9% [p = 0.009]) and tumor size (<6 cm: 84.4% vs 57.1% [p < 0.001]; ≥6 cm: 57.1% vs 20.0% [p = 0.004]). Notably, when combined with chemoradiotherapy, surgery achieved significantly higher OS rates than chemoradiotherapy alone (64.3% vs 37.0%; p = 0.002). Surgical management is associated with significantly improved OS in GEA-C, especially among patients presenting with locally advanced disease. The integration of surgery with chemoradiotherapy demonstrated potentially enhanced therapeutic efficacy relative to chemoradiotherapy as a stand-alone approach.