Clinicopathological features and outcomes in different histologic subtypes of HPV-independent endocervical adenocarcinomas

Background: We aim to analyze the clinicopathological features and outcomes among different histologic subtypes of HPV-independent endocervical adenocarcinomas（HPVI ECAs). Methods: : Forty-five HPVI ECAs, including 16 minimal deviation adenocarcinoma (MDA), 17 non-MDA type of gastric adenocarcinoma (GAS), and 12 non-GAS HPVI ECAs were studied. Data of clinical features, pathological characteristics, treatment, and outcomes were evaluated. Results: : The median age of patients with GAS was 46 years old (IQR: 41.5, 59.5), with no significant difference compared to patients with non-GAS HPVI ECA (48-year-old, IQR: 40.5, 60.5) ( p =0.92). Compared with non-GAS HPVI ECAs, GAS hade more common complains of vaginal watery discharge ( p =0.047). GAS cases were also associated with higher clinical stage at diagnosis (P=0.016), deeper cervical stromal invasion ( p =0.01), and worse 5-year progression free survival (PFS) ( p =0.032). Compared with non-MDA GAS, MDA had similar clinical and pathological features and prognosis. Of note, cytology results showed a lower positivity rate for HPVI ECAs (65.2% for GAS and 60% for non-GAS HPVI ECA), and MDA had a lower positivity rate than that for non-MDA (40.0% vs 84.6%, p =0.026). Serum CA19-9 levels were significantly higher in MDA than those in non-MDA (184.5 U/ml vs 22.4U/ml, p =0.045) and non-GAS cases (184.5U/ml vs 10.6U/ml, p =0.006). Conclusions: : GAS HPVI ECA had different clinical presentation with genital watery discharge compared with non-GAS HPVI ECA cases. Comparison with those of non-GAS HPVI ECAs, GAS cases were more likely to have high risk pathological factors and poorer PFS. Serum CA19-9 may be helpful for diagnosis and screening in patients with GAS, especially those with MDA.