| Summary: | (1) <i>Background</i>: This study examined the use of a two-tier system in grouping cervical adenocarcinoma for survival discrimination. (2) <i>Methods</i>: A nationwide retrospective observational cohort study was conducted using the Japan Society of Gynecologic Oncology tumor registry database from 2001 to 2015 (<i>n </i>= 86,754). Adenocarcinoma subtypes were grouped as type 1 (endocervical usual type and endometrioid) or type 2 (serous, clear, mucinous, and not otherwise specified), based on their relative survival compared with that of squamous tumors. (3) <i>Results</i>: The majority of the adenocarcinoma cases were type 1 (<i>n </i>= 10,121) versus type 2 tumors (<i>n </i>= 5157). Type 2 tumors were more likely to be old and have stage IV disease than those with squamous tumors. The number of type 2 tumors increased from 2001 to 2014 (106.1% relative increase, <i>p </i>< 0.001). Type 2 tumors had disproportionally poorer survival compared to other types (5-year survival rates: 68.9% for type 2, 75.4% for type 1, and 78.0% for squamous; <i>p </i>< 0.001). On multivariate analysis, type 2 tumors remained an independent prognostic factor associated with decreased survival compared with squamous (adjusted hazard ratio 2.00, 95% CI 1.84–2.15, <i>p </i>< 0.001). (4) <i>Conclusion</i>: The survival of cervical adenocarcinoma varies largely across the histological subtypes, and the proposed two-tier grouping may be useful for survival discrimination.
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