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基于国际颈管腺癌标准与分类286例宫颈腺癌临床病理与预后分析

Endocervical adenocarcinomas classified by International Endocervical Adenocarcinoma Criteria and Classification: a clinicopathological and prognostic analysis of 286 cases

摘要:

目的:探讨国际颈管腺癌标准与分类(IECC)在中国妇女宫颈腺癌中的临床病理意义及预后评估价值。方法:收集浙江大学医学院附属妇产科医院2013年1月至2019年12月宫颈腺癌病例286例,复习HE切片,按IECC重新分类,分析各组织学类型与p16免疫组织化学染色、人乳头状瘤病毒(HPV)mRNA原位杂交(RNAscope)结果、国际妇产科联盟(FIGO)分期等临床病理参数以及预后之间的相关性。结果:宫颈腺癌发病年龄19~77岁(中位年龄47岁)。FIGOⅠ期223例,Ⅱ期22例,Ⅲ期38例,Ⅳ期3例。按IECC分类,HPV相关腺癌(HPVA)213例(74.5%)、非HPV相关腺癌(NHPVA)60例(21%)和腺癌-非特指类型(NOS)13例(4.5%)。HPVA、NHPVA的组织学亚型分别以普通型(156例,54.5%)和胃型(46例,15.9%)最常见。HPVA、NHPVA和腺癌-NOS,p16阳性占比分别为173/188(91.8%)、17/64(26.6%)和8/13,HPV mRNA阳性占比分别为144/161(89.4%)、0/18和7/13。与HPVA相比,NHPVA具有发病年龄大、FIGO分期高、神经侵犯、脉管内瘤栓、p53突变型表达率高等特点( P<0.05)。年龄>47岁、NHPVA、胃型、FIGOⅡ~Ⅳ期、脉管内瘤栓、神经侵犯、p53突变型表达等为总生存、肿瘤复发的预后不良因素( P<0.01)。在HPVA,黏液型组预后比普通型组差( P<0.05)。多因素生存分析发现,FIGOⅡ~Ⅳ期、NHPVA和p53突变型表达是宫颈腺癌总生存的独立预后不良因素,FIGOⅡ~Ⅳ期和胃型腺癌为肿瘤复发的独立预后因素( P<0.05)。 结论:IECC将宫颈腺癌分为HPVA和NHPVA有很好的病因学、临床病理意义与预后评估价值。

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abstracts:

Objectives:To investigate the clinicopathological and prognostic significance of International Endocervical Adenocarcinoma Criteria and Classification (IECC) in classifying endocervical adenocarcinomas among Chinese women.Methods:A total of 286 endocervical adenocarcinomas diagnosed from January 2013 to December 2019 at the Women′s Hospital, Zhejiang University School of Medicine were identified and included. The cases were reviewed and reclassified based on IECC. The histological types were correlated with p16 immunostaining, human papilloma virus (HPV) mRNA status, the clinicopathological parameters including the International Federation of Gynecologic Oncology (FIGO) stage, and clinical follow-up data.Results:The patients aged from 19 to 77 (median 47) years. There were 223 patients at FIGO stage Ⅰ, 22 at stage Ⅱ, 38 at stage Ⅲ and 3 at stage Ⅳ. The IECC types included 213 (74.5%) HPV-related adenocarcinomas (HPVA), 60 (21%) non-HPV-related adenocarcinomas (NHPVA), and 13 (4.5%) adenocarcinomas, no other specified (NOS). The major histological subtypes in HPVA and NHPVA were common type ( n=156, 54.5%) and gastric type (GAC, n=46, 15.9%), respectively. The p16 positive rates in HPVA, NHPVA and adenocarcinoma, NOS were 92% (173/188), 26.6% (17/64) and 61.5% (8/13), respectively, and those of HPV mRNA hybridization in situ were 89.4% (144/161), 0/18 and 7/13, respectively. Compared to HPVA, NHPVA was more frequently associated with older age, FIGO stage Ⅱ-Ⅳ, neural involvement, lymphovascular invasion and aberrant p53 expression ( P<0.05). Univariate survival analysis showed that age (>47 years), NHPVA, GAC, FIGO stage Ⅱ-Ⅳ, neural involvement, lymphovascular invasion and aberrant p53 expression were indicators for a poorer overall survival and tumor recurrence ( P<0.05). Mucinous HPVA showed worse clinical outcomes compared to usual-type HPVA ( P<0.01). Multivariate survival analysis demonstrated that FIGO stage Ⅱ-Ⅳ, NHPVA and aberrant p53 expression were independent indicators for poor overall survival while FIGO stage Ⅱ-Ⅳ and GAC were independently associated with tumor recurrence ( P<0.05). Conclusions:The two broad IECC categories, HPVA and NHPVA, not only provide morphological links to the etiology (HPV infection), but also have significant clinicopathological and prognostic relevance.

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作者: 吕炳建 [1] 石海燕 [1] 邵颖 [1] 刘琴 [1] 吕卫国 [2]
期刊: 《中华病理学杂志》2021年50卷9期 1014-1019页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.cn112151-20210524-00374
发布时间: 2022-06-15
基金项目:
国家自然科学基金 国家重点研发项目 National Natural Scientific Foundations of China National Key Research and Development Program of China
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