| Objective: To investigate the difference of clinical and pathologic variables between cervical squamous carcinoma and cervical adenocarcinoma and the prognostic factors of cervical adenocarcinoma.According to the Silva pattern,a grading model based on tumor invasion,we will investigate the relationship between clinicopathological features and the invasive pattern of HPV-associated(HPVA)common cervical adenocarcinoma and the implications for prognosis.Methods: We conducted a retrospective review of 253 patients with cervical squamous carcinoma and 94 patients with cervical ad enocarcinoma who were diagnosed by surgical pathology in the Affiliated Hospital of Qingdao University from January 2012 to December 2018.All patients underwent surgical treatment.Clinicopathological and follow-up data of the two groups were recorded and collated.The follow-up date was up to December 31,2021.The clinical stage of all patients was also reviewed based on 2018 International Federation of Gynecology and Obstetrics(FIGO)criteria.All statistical analyses were performed in SPSS 26.0.Compare and analyze the clinicopathological features of cervical squamous carcinoma and cervical adenocarcinoma.Study on the factors affecting the prognosis of cervical adenocarcinoma by survival analysis.According to International Endocervical Adenocarcinoma Criteria and Classification(IECC),cervical adenocarcinoma was divided into HPV-associated(HPVA)adenocarcinoma and HPV-independent(HPVI)adenocarcinoma.HPVA common cervical adenocarcinoma was divided into A,B and C types according to the Silva system based on “pattern of invasion”.Compare and analyze the clinicopathological features and prognosis of HPVA common cervical adenocarcinoma based on the Silva classification system.Results: 1.The mean age of diagnosis was 54.58±8.21 years in patients with cervical squamous carcinoma and 48.57±9.12 years in patients with cervical adenocarcinoma.144 cases(56.92%)were premenopausal in cervical squamous carcinoma group,and 66cases(70.21%)were premenopausal in cervical adenocarcinoma group.There were 66cases(26.09%)with family history of malignant neoplasms(MN-FH)in cervical squamous cell carcinoma group,14 cases(14.89%)with MN-FH in cervical adenocarcinoma group.Vaginal bleeding was the main symptom in patients with cervical squamous cell carcinoma and cervical adenocarcinoma.Vaginal discharge is more common in cervical adenocarcinoma group than in cervical squamous cell carcinoma group(17.02% vs.4.35%).Cervical abnormality was found in 156 cases(61.66%)in cervical squamous cell carcinoma group,cervical abnormality in 54 cases(57.45%)in cervical adenocarcinoma group.According to the staging criteria of FIGO 2018,in cervical squamous cell carcinoma group,there were 10 cases in stageⅠA1 and 3 cases in stageⅠA2,59 cases in stageⅠB1,87 cases in stageⅠB2,and 32 cases in stageⅠB3,5cases in stageⅡA1 and 2 cases in stageⅡA2,54 cases in stage ⅢC1p and 1 case in stage ⅢC2p.In cervical adenocarcinoma group,there were 3 cases in stageⅠA1 and 8cases in stageⅠA2,39 cases in stageⅠB1,21 cases in stageⅠB2,and 3 cases in stageⅠB3,20 patients in stage ⅢC1p.Among all HPV-positive patients,in cervical squamous cell carcinoma group,66(83.54%)patients were HPV16 infection and 6(7.59%)patients were HPV18 infection.In cervical adenocarcinoma group,12(52.17%)patients were HPV16 infection and 10(43.48%)patients were HPV18 infection.2.There were significant differences in the depth of invasion(DOI),degree of differentiation,lymph vascular space invasion(LVSI)between 253 cervical squamous cell carcinoma patients and 94 cervical adenocarcinoma patients(p<0.05).Patients with cervical squamous cell carcinoma have a higher incidence of the DOI > 1/2,poorly differentiated d egree and positi ve LVSI than patients with cervical adenocarcinoma.In contrast,there were no statistically significant differences in tumor size,lymph node metastasis(LNM),perineural invasion(PNI),parametrial involvement(PI)and ovarian metastasis(OM)(p> 0.05).The 3-year and 5-year overall survival(OS)rates were 95.00% and 87.50%,in sequence,for cervical squamous cell carcinoma group.The 3-year and 5-year OS rates were 89.7% and 76.90%,in sequence,for cervical adenocarcinoma.The differences were statisti cally significant in OS rates between cervical squamous cell carcinoma and cervical adenocarcinoma(p=0.035).3.Univariate analysis of the prognosis of 94 cases cervical adeno carcinoma showed that MN-FH,FIGO stage,DOI,LNM,LVSI,and PNI were statistically significant for the prognosis of the patients.After adjustment for factors that were significant in univariate analysis,multivariate analysis showed that MN-FH,FIGO stage,LNM,and PNI were significantly associated with shorter OS.Multivariate Cox regression analysis revealed that the FIGO stage,and LNM were significantly associated with shorter progression-free survival(PFS).4.Among the 72 cases of HPVA common adenocarcinoma,8 patients(11.11%)had morphologic features that corresponded to pattern A,16 patients(22.22%)were categorized as pattern B,and the remaining 48 patients(66.67%)were categorized as pattern C.Diagnostic age,menopause,FIGO stage,degree of differentiation,DOI and LNM were different among the pattern A,B,and C(p<0.05).25% of the patients with Silva C tumors had higher stage,and the rate of lymph node metastasis was 25%.In contrast,we did not find differences in MN-FH,clinical feature,cervical gynecological examination,tumor size,LVSI,PNI,PI and OM among the patients with pattern A,B,and C(p > 0.05).5.During the follow-up period,there was no recurrence in patients with Silva A tumor,but 1 patient(6.25%)with Silva B tumor and 13 patients(27.08%)with Silva C tumor relapsed.Both patients with Silva A and B tumors survived,and 37patients(77.08%)with Silva C tumor survived.Kaplan-Meier survival curve analysis(Log Rank test)demonstrated statistically significant differences in OS rate and PFS rate among Silva A,B and C tumors(p=0.034,p=0.046).Conclusion: 1.Patients with Cervical adenocarcinoma tended to be younger and had a worse prognosis than patients with cervical squamous cell carcinoma.2.Multivariate analysis of the prognosis of cervical adeno carcinoma revealed independent prognostic factors as tumor stage,LNM,PNI,MN-FH.3.Patients with HPVA common cervical adenocarcinoma with pattern C tumors had a later stage,were more likely to have LNM,and had the worst prognosis. |
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