基于国际宫颈腺癌分类标准(IECC)分类的HPV相关和非相关宫颈腺癌的临床结局

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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。
  国际宫颈腺癌分类标准(International Endocervical Adenocarcinoma Criteria and Classification,IECC)根据与病因学[也就是人乳头状瘤病毒(human papilloma virus,HPV)感染]相关的形态学特征将宫颈腺癌(endocervical adenocarcinomas,ECA)分为HPV相关型(HPV-associated,HPVA)和非HPV相关型(non-HPVA,NHPVA)。据报道,在老年人群,NHPVA大且处于高分期。本研究的目的是检测这些肿瘤类型的临床结局。205例ECA的完整切片来自全球7家研究机构,并依据IECC标准及有无HPV对它们进行分类。临床与形态学参数与随访数据相关联。采用Kaplan-Meier生存分析对总生存率(overallsurvival,OS)、无病生存率(disease-free survival,DFS)和无进展生存率(progression-free survival,PFS)进行分析,并采用单变量对数秩和检验进行比较。进行多变量生存分析,生存终点为OS、DFS和PFS。比较发现以下类别具有统计学意义的生存差异(OS、DFS和PFS):HPVA>NHPVA(即HPVA情况下的存活率较高),包括接受外科手术及后续辅助治疗的患者;普通型HPVA>黏液型HPVA;FIGO3期HPVA>NHPVA;2者都存在淋巴血管侵犯时,HPVA>NHPVA;以及有盆腔复发患者的HPVA>NHPVA。尽管倾向于HPVA较NHPVA预后更好,但在下列类别中无统计学差异:黏液型HPVA vs .NHPVA;HPVA vs .NHPVA,2者都伴有淋巴结转移时;以及都有远处转移的HPVAvs.NHPVA患者。HPVA与NHPVA患者手术后无辅助治疗时,生存率相似。FIGO分期在HPVA中无预后意义。对HPVA的多变量分析表明,分期与OS和DFS(P分别=0.07和0.06)之间以及Silva浸润模式与OS之间有近乎显著的统计学相关(P=0.09)。NHPVA的多变量分析表明,OS与年龄(P=0.03)、分期(P=0.02)和肿瘤大小(P=0.002)以及DFS与分期(P=0.004)、肿瘤大小(P=0.004)间均有统计学意义。HPVA和NHPVA共同的多变量分析表明,OS与HPV状态和分期有近乎显著的相关性(2者P值均=0.06)。对于DFS,分期是1个显著变量(P=0.04),而HPV状态和肿瘤大小是近乎显著相关(P分别=0.06和0.07)。临床结局研究支持以下观点,即IECC分类不仅能根据HPV状态(通常是在H&E切片上评估)对ECA进行分类,同时也具有重要临床意义。
 Am J Surg Pathol 2019;43:466–474
  美国外科病理学杂志中文版2019年第四期摘要NO.7
  (何琼琼 翻译 周建华 审校)

  The American Journal of Surgical Pathology中文版声明:
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