通过评估基于二元席尔瓦模式的分类,改进人乳头状瘤病毒相关宫颈内膜腺癌的风险预测:由国际妇科病理学家协会 (ISGyP) 主导的一项国际多中心回顾性观察研究。

IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY International Journal of Gynecological Pathology Pub Date : 2024-09-01 Epub Date: 2024-05-20 DOI:10.1097/PGP.0000000000001033
Aime Powell, Anjelica Hodgson, Paul A Cohen, Joseph T Rabban, Kay J Park, W Glenn McCluggage, C Blake Gilks, Naveena Singh, Esther Oliva
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引用次数: 0

摘要

宫颈内膜腺癌(EAC)是一类恶性肿瘤,其发病机制、形态和临床表现各不相同。作为国际妇科病理学家协会国际宫颈内膜腺癌项目的一部分,我们建立了一个大型的国际 EAC 回顾性队列,以研究潜在的具有预后意义的临床病理特征,从而为这些患者的治疗提供指导。在这项研究中,我们努力为接受手术治疗的国际妇产科联盟(FIGO)IA2 至 IB3 期腺癌建立一个强大的人乳头状瘤病毒(HPV)相关 EAC 预后模型,该模型结合了患者年龄、淋巴管间隙侵犯(LVSI)状态、FIGO 分期以及根据 Silva 系统(传统的 3 级系统)确定的侵犯模式。最近,有人提出了一种2级/二元席尔瓦侵袭模式系统,将腺癌分为低危(无LVSI的A/B模式)和高危(有LVSI的B/C模式)两类。我们的队列包括 792 例与 HPV 相关的 EAC 患者。多变量分析表明,二元席尔瓦侵袭模式分类与无复发生存率和疾病特异性生存率相关(P < 0.05),而 FIGO 2018 I 期亚型与之无关。对目前3级系统的评估显示,与A型肿瘤患者相比,B型肿瘤患者的疾病特异性生存率与C型肿瘤患者的疾病特异性生存率没有显著差异。这些研究结果突出表明,有必要开展前瞻性研究,进一步探讨I期HPV相关EAC亚分期的预后意义,并将二元席尔瓦侵袭模式分类(包括LVSI状态)作为治疗建议的一个组成部分。
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Improved Risk Prediction in Human Papillomavirus-Associated Endocervical Adenocarcinoma Through Assessment of Binary Silva Pattern-based Classification: An International Multicenter Retrospective Observational Study Led by the International Society of Gynecological Pathologists (ISGyP).

Endocervical adenocarcinomas (EACs) are a group of malignant neoplasms associated with diverse pathogenesis, morphology, and clinical behavior. As a component of the International Society of Gynecological Pathologists International Endocervical Adenocarcinoma Project, a large international retrospective cohort of EACs was generated in an effort to study potential clinicopathological features with prognostic significance that may guide treatment in these patients. In this study, we endeavored to develop a robust human papillomavirus (HPV)-associated EAC prognostic model for surgically treated International Federation of Gynecology and Obstetrics (FIGO) stage IA2 to IB3 adenocarcinomas incorporating patient age, lymphovascular space invasion (LVSI) status, FIGO stage, and pattern of invasion according to the Silva system (traditionally a 3-tier system). Recently, a 2-tier/binary Silva pattern of invasion system has been proposed whereby adenocarcinomas are classified into low-risk (pattern A/pattern B without LVSI) and high-risk (pattern B with LVSI/pattern C) categories. Our cohort comprised 792 patients with HPV-associated EAC. Multivariate analysis showed that a binary Silva pattern of invasion classification was associated with recurrence-free and disease-specific survival (P < 0.05) whereas FIGO 2018 stage I substages were not. Evaluation of the current 3-tiered system showed that disease-specific survival for those patients with pattern B tumors did not significantly differ from that for those patients with pattern C tumors, in contrast to that for those patients with pattern A tumors. These findings underscore the need for prospective studies to further investigate the prognostic significance of stage I HPV-associated EAC substaging and the inclusion of the binary Silva pattern of invasion classification (which includes LVSI status) as a component of treatment recommendations.

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来源期刊
CiteScore
3.90
自引率
12.50%
发文量
154
审稿时长
6-12 weeks
期刊介绍: International Journal of Gynecological Pathology is the official journal of the International Society of Gynecological Pathologists (ISGyP), and provides complete and timely coverage of advances in the understanding and management of gynecological disease. Emphasis is placed on investigations in the field of anatomic pathology. Articles devoted to experimental or animal pathology clearly relevant to an understanding of human disease are published, as are pathological and clinicopathological studies and individual case reports that offer new insights.
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