Association between Silva pattern-based classification and endocervical adenocarcinoma: a systematic review and meta-analysis

Objective To determine the relationship between the Silva pattern-based classification system and endocervical adenocarcinoma. Methods The PubMed, Embase, Central Cochrane Library, and Web of Science databases were systematically searched for studies that investigated the correlation between the Silva classification system and the oncology prognosis or pathological features of endocervical adenocarcinoma, published in the period from January 2013 to March 2024. Results A total of 19 eligible studies including 3122 cases were included in this systematic review and meta-analysis. The combined death rate in the Silva A, Silva B, and Silva C patterns was 0% (95% CI 0.0% to 0.4%), 2.6% (95% CI 0.4% to 5.9%), and 14.0% (95% CI 9.4% to 19.2%), respectively; the combined recurrence rate in the Silva A, Silva B, and Silva C patterns was 0.1% (95% CI 0.0% to 1.2%), 5.1% (95% CI 1.6% to 10.0%), and 19.4% (95% CI 14.7% to 24.4%), respectively; the combined lymphovascular invasion rate in the Silva A, Silva B, and Silva C patterns was 0% (95% CI 0.0% to 0.5%), 21.0% (95% CI 16.9% to 25.4%), and 58.8% (95% CI 50.1% to 67.3%), respectively; and the combined International Federation of Gynecology and Obstetrics (FIGO) I rate in the Silva A, Silva B, and Silva C patterns was 99.3% (95% CI 97.6% to 100%), 93.7% (95% CI 86.4% to 98.7%), and 82.4% (95% CI 74.9% to 88.9%), respectively. Conclusion Our study found that Silva A was negatively correlated with death rate, while Silva C was positively correlated. There was no correlation regarding the death rate for Silva B. Based on these findings, it is suggested that the Silva pattern-based classification system can predict the prognosis of human papillomavirus (HPV)-related endocervical adenocarcinoma and assist in guiding patient treatment. Data are available in a public, open access repository. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.