Comprehensive clinical analysis of cervical clear cell adenocarcinoma: A real-world multicenter study.

Abstract

e17525 Background: Cervical clear cell adenocarcinoma (CCAC) is a rare and aggressive malignancy for which evidence-based management strategies are lacking. This study aimed to characterize the real-world clinicopathological features, treatment patterns, and outcomes of patients with CCAC. Methods: We retrospectively analyzed clinical data from 553 patients diagnosed with CCAC between 1993 and 2024 across 26 tertiary hospitals in China. Clinicopathological features, therapeutic approaches, and survival outcomes were assessed. Patients were categorized according to the 2018 FIGO staging system into early-stage (IA1–IB2, IIA1), locally advanced (IB3, IIA2–IIB), lymph node metastasis (IIIC), and advanced-stage disease (IIIA, IIIB, and IV). The primary outcome was overall survival (OS) at 5 years. Treatment outcomes and prognostic factors were assessed using Kaplan-Meier curves and Cox-regression models. Results: A total of 553 patients were included, with a median age of 50 years (IQR, 39–58). Patients were often diagnosed at an early-stage (54.4%), with 5-year OS rates exceeding 90% and declining progressively with stage. Surgery was identified as an independent favorable prognostic factor (HR 0.34 [95% CI 0.12-0.95]). Among patients with early-stage disease, low-risk patients achieved favorable outcomes with surgery alone, whereas intermediate-risk patients demonstrated improved OS with adjuvant chemotherapy. In non–early-stage disease, combined treatment with surgery and radiotherapy was associated with the best survival outcomes in locally advanced and node-positive subgroups. Vaginal bleeding was the most common presenting symptom (83.9%). Regarding initial diagnostic evaluation, imaging showed the highest abnormality detection rate (82.2%), outperforming cytology (54.8%) and human papillomavirus (HPV) testing (17.9%). Conclusions: This study provides an up-to-date overview of CCAC, highlighting that surgery plays a central role in its management and the importance of individualized adjuvant therapies. In early-stage disease, surgery alone is appropriate for low-risk patients, whereas adjuvant chemotherapy may be considered for those at intermediate risk. In non–early-stage disease, incorporating surgery into multimodal treatment with (chemo)radiotherapy is associated with superior survival compared with non-surgical or surgery-alone approaches. The low detection rates of HPV and cytology testing underscore the limitations of standard cervical screening in CCAC and emphasize the critical role of clinical evaluation and imaging in symptomatic patients.