摘要
目的:探讨人乳头瘤病毒(HPV)相关性普通型子宫颈腺癌Silva分型与临床病理特征的关系及对预后的指导意义。方法:回顾性分析在青岛大学附属医院2012年1月至2018年12月接受手术治疗的72例子宫颈腺癌患者,随访至2021年12月31日,根据2018年国际妇产科联盟(FIGO)子宫颈癌分期标准修正所有病例分期,根据Silva分型模式标准将HPV相关性普通型子宫颈腺癌分为Silva A型、Silva B型、Silva C型,分析HPV相关性普通型子宫颈腺癌Silva分型的临床病理特征的差异及预后。结果:72例HPV相关性普通型子宫颈腺癌中Silva A型、Silva B型、Silva C型的患者分别为8例(11.11%)、16例(22.22%)、48例(66.67%)。3组患者的确诊年龄、绝经状态、FIGO分期、分化程度、浸润深度及淋巴结转移的比例差异均有统计学意义(P<0.05),其中Silva C型患者分期为Ⅲ期及以上者占33.33%,淋巴结转移率为25.00%;而临床表现、子宫颈查体、肿瘤大小、淋巴脉管浸润、神经侵犯、宫旁浸润及卵巢转移差异均无统计学意义(P>0.05)。随访期间Silva A型患者无复发,Silva B型患者1例(6.25%)复发,Silva C型患者13例(27.08%)复发,Silva A、B型患者均存活,Silva C型患者存活者37例(77.08%),Silva A、B、C 3组患者的总生存期曲线及无进展生存期曲线比较,差异有统计学意义(P=0.034;P=0.046)。结论:HPV相关性普通型子宫颈腺癌的Silva C型患者的分期偏晚,更容易发生淋巴结转移,生存率更低。
Objective:To investigate the relationship between Silva pattern of human papillomavirus(HPV)-related common cervical adenocarcinoma and clinicopathological features and its guiding significance for prognosis.Methods:We conducted a retrospective review of 72 patients with cervical adenocarcinoma who were diagnosed by surgical pathology in the Affiliated Hospital of Qingdao University from January 2012 to December 2018.The follow-up date was up to December 31,2021.The clinical stage of all patients was also reviewed based on the 2018 International Federation of Gynecology and Obstetrics(FIGO)criteria.HPV-associated common cervical adenocarcinoma was divided into A,B and C types according to the Silva pattern based on“pattern of invasion”.Compare and analyze the differences in the clinicopathological features and prognosis of HPV-associated common cervical adenocarcinoma with different Silva pattern.Results:Among the 72 cases of HPV-associated 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,depth of invasion and lymph node metastasis were different among the pattern A,B,and C(P<0.05).33.33%of the patients with Silva C tumors had higher stage,and the rate of lymph node metastasis in patients with Saliva C tumors was 25.00%.In contrast,we did not find differences in clinical feature,cervical gynecological examination,tumor size,lymph vascular space invasion,perineural invasion,parametrial involvement and ovarian metastasis among the patients with pattern A,B,and C(P>0.05).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 37 patients(77.08%)with Silva C tumor survived.Kaplan-Meier survival curve analysis(Log Rank test)demonstrated statistically significant differences in overall survival rate and progression-free survival rate among Silva A,B and C tumors(P=0.034,P=0.046).Conclusions:Patients with HPV-associated common cervical adenocarcinoma with pattern C tumors had a later stage,were more likely to have lymph node metastasis,and had the worst prognosis.
作者
张冉
孔琰
王光宁
王宁
ZHANG Ran;KONG Yan;WANG Guangning(Department of Gynecology,The Affiliated Hospital of Qingdao University,Qingdao Shandong 266000,China;Department of Gynecology,The Third People′s Hospital of Qingdao,Qingdao Shandong 266041,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2023年第6期449-453,共5页
Journal of Practical Obstetrics and Gynecology
关键词
子宫颈腺癌
临床病理特点
Silva分型
预后
Cervical adenocarcinoma
Clinicopathological features
Silva pattern system
Prognosis
