卵巢子宫内膜样癌FIGO与Silverberg分级系统预后比较分析

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   --本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。
  摘要:国际妇产科联合会(International Federation of Obstetrics and Gynecology,FIGO)子宫内膜癌分级系统目前在许多实践中应用于卵巢子宫内膜样癌(ovarian endometrioid carcinoma,OEC)。然而,既往报道称,通过采用Silverberg分级系统治疗的卵巢癌具有更好的预后。因此,仍然需要在OEC中对FIGO和Silverberg进行细致深入地比较。对本机构诊断的共72例OEC使用两种系统进行独立评级。Silverberg分级(grade,G)是基于结构、核异型性和核分裂象的综合评分。FIGO分级是基于非鳞化实性成分的百分比;重度异型可升级FIGO结构分级(G1升至G2或G2升至G3)。通过等级对病例的分组与无病生存(disease-free survival,DFS)、疾病特异生存(disease-specific survival,DSS)和总体生存(overall survivial,OS)有关。11例(15.3%)OEC为双侧,26例(36.1%)伴卵巢表面受累,12例(16.7%)伴淋巴血管侵犯。47例OEC是I期(65%),16例(22%)为II期,9例(13%)为III期。中位随访时间为62个月(范围:1~179个月)。中位DFS为60.5个月(1~179个月);中位OS为61个月(1~179个月)。16例(22%)OEC复发,9例(13%)患者死于该疾病。在单因素分析中,FIGO和Silverberg均与DFS、DSS和OS显著相关(均P<0.05)。然而,在多因素分析中进行比较时,只有Silverberg与生存率保持统计学相关性(P<0.05)。与G3相比,Silverberg分级评估的G1+G2 OEC具有明显更好的DFS、DSS和OS;用FIGO未观察到这种区别。即便诊断5年后,SilverbergG1和G2肿瘤的存活率仍相近,而FIGO G2肿瘤在前5年的存活率接近G1,但5年后显著下降并接近G3肿瘤。肿瘤侧别、淋巴血管侵犯与分期也和预后相关。多因素分析显示,分期与预后的关系优于所有其他变量。如目前所定义的,Silverberg分级系统是比FIGO更好的生存预测系统。这种差异可以通过OEC的G2组来解释,Silverberg的G2与G1肿瘤可合并一类,并且与FIGO G2相比具有较良好的生物学行为。因此,Silverberg分级可能适合对低、高风险类别的患者进行分层,以利于预后和疾病管理。
  关键词:卵巢癌,子宫内膜样,卵巢子宫内膜样癌,FIGO,Silverberg,级别,分级
  (Am J Surg Pathol 2019;43:161-167)
  美国外科病理学杂志中文版2019年第三期摘要NO.13
  ( 肖遥星 翻译 周先荣 审校 )








 
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