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）
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©2018 Wolters Kluwer Health
The material is published by Wolters Kluwer Health with the permission of American Journal of Surgical Pathology.No part of this publication may be reproduced in any form,stored in a retrieval system or transmitted in any form,by any means,without prior written permission from Wolters Kluwer Health.Opinions expressed by the authors and advertisers are not necessarily those of the American Journal of Surgical Pathology, its affiliates,or of the Publisher.The American Journal of Surgical Pathology,its affiliates,and the Publisher disclaim any liability to any party for the accuracy,completeness,efficacy,or availability of the material contained in this publication (including drug dosages) or for any damages arising out of the use or non-use of any of the material contained in this publication.
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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；所有文章仅供公益交流，不代表本站立场。欢迎提供素材、资料等，投稿邮箱： tougao@91360.com，一经采纳将给予稿费】
©2018 Wolters Kluwer Health
The material is published by Wolters Kluwer Health with the permission of American Journal of Surgical Pathology.No part of this publication may be reproduced in any form,stored in a retrieval system or transmitted in any form,by any means,without prior written permission from Wolters Kluwer Health.Opinions expressed by the authors and advertisers are not necessarily those of the American Journal of Surgical Pathology, its affiliates,or of the Publisher.The American Journal of Surgical Pathology,its affiliates,and the Publisher disclaim any liability to any party for the accuracy,completeness,efficacy,or availability of the material contained in this publication (including drug dosages) or for any damages arising out of the use or non-use of any of the material contained in this publication.
Although advertising material is expected to conform to ethical (medical) standards,inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer.
【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；所有文章仅供公益交流，不代表本站立场。欢迎提供素材、资料等，投稿邮箱： tougao@91360.com，一经采纳将给予稿费】
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