| Objective:The clinical and prognostic grading system of endocervical adenocarcinoma(EAC)is still incomplete.Currently,the pattern-based classification according to Silva and International Endocervical Adenocarcinoma Criteria and Classification(IECC)have been proposed but not universally applied,asking for further validation.This study aimed to discuss the clinicopathological features and prognostic factors of EAC,and to investigate the distribution of Silva pattern and IECC classification in patients with EAC.Then this study tried to explore the prognostic value of the new systems for clinicopathological outcomes,and put forward reasonable hypothesis and suggestions for effective stratification and individualized treatment of patients.Methods:The clinical and pathological data of primary EAC patients diagnosed by pathology in the department of gynecology,Shandong Provincial Hospital from June 2010 to May 2020 were retrospectively collected.Representative slices from tumor tissue specimens of all cases were carefully evaluated by two experiential and professional pathologists under microscopy.Histopathological type was confirmed and Silva pattern as well as IECC classification were also judged according to the unified standards.At the same time,pathological parameters such as lymph vascular space invasion,perineural invasion,lymph node metastasis,ovarian metastasis,tumor depth of invasion and tumor thickness were confirmed.And the clinical stage of all cases was also revised according to the 2018 FIGO criteria.Then the postoperative complications,tumor progression and survival of the patients were followed up.Correlation test and survival analysis were applied to determine the prognostic risk factors for EAC and to compare the overall and progression free survival among three groups of Silva patterns.Moreover,the prognostic efficacy of Silva pattern-based classification and IECC for unusual types of EAC and non-HPV-associated EAC were evaluated by combined analysis.Results:A total of suitable 144 cases were collected in this study,including 96 cases of Usual type and 48 cases of unusual types.Among 95 samples that could be clearly classified,there were 13 cases of Silva pattern A,6 cases of Silva pattern B,76 cases of Silva pattern C;80 cases of HPVA,and 15 cases of NHPVA.Survival analysis showed that the overall survival(OS)and progression-free survival(PFS)in Silva pattern A/B group were better than those in pattern C group;On the whole,patients with IB3/IIA2～IVB stage,lymph node and ovarian metastasis,negative HPV detection,abnormal physical signs,highly D-dimer level,tumor thickness>5mm,Silva pattern C,positive LVSI and PNI had poor OS and PFS as well as poor prognosis with statistically significance.In Silva pattern C group,the risk factors for poor prognosis were highly D-dimer level,lately clinical stage,tumor thickness>5mm,positive LVSI,low tumor diferentiation and lymph node metastasis.In the unusual types of EAC patients,the proportions of Silva pattern C and NHPVA were higher than those in the Usual type.According to survival analysis,the prognostic efficacy of Silva pattern-based classification for unusual types and NHPVA was lower than that for Usual type and HPVA.Conclusion:Silva pattern-based classification judging from tumor growth pattern is of great value for the EAC grading.In addition to the Usual type and HPVA type,it also has a certain prognostic effect for some rare types and NHPVA of EAC patients,Silva pattern-based classification combined with IECC classification has great advantages in stratified management of EAC,which assisted by FIGO stage and certain risk factors can provide reasonable shunt methods among EAC patients to make benefits. |
PDF Full Text Request