Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing 100191, China.
Department of Pathology, Dalian Obstetrics and Gynecology Hospital, Liaoning Province 116000, China.
Hum Pathol. 2019 Feb;84:35-43. doi: 10.1016/j.humpath.2018.08.029. Epub 2018 Sep 13.
As a new pattern-based classification, the Silva pattern system has been recently developed to evaluate invasive lymph node metastasis and the prognosis of endocervical adenocarcinoma (EAC). Therefore, our study was conducted to explore the reproducibility and prognostic significance of this system in a multi-institutional Chinese cohort, with the goal of revising and expanding its application. The clinicopathological data of 191 EAC patients from 3 medical centers were examined in a retrospective manner. The Silva pattern system demonstrated great prognostic value, significance in guiding treatment selection, and acceptable reproducibility in 191 patients that included additional histologic variants and 124 usual-type EAC patients. Collectively, compared with usual-type EAC, the whole cohort demonstrated similar statistical significance for relevant clinicopathological parameters, such as International Federation of Gynecology and Obstetrics stage (R = 0.612 versus R = 0.600), tumor thickness (P < .0001 versus P < .0001), lymphovascular invasion (P < .0001 versus P < .0001), lymph node metastasis (P = .033 versus P = .018), perineural invasion (P = .003 versus P = .001), and recurrence-free survival (P = .047 versus P = .020). Moreover, perineural invasion was significantly correlated (P = .001) with the Silva pattern system and appeared in most Silva C tumors. In conclusion, the Silva pattern system is consistent with the biological behavior of EAC and has acceptable reproducibility. Compared with International Federation of Gynecology and Obstetrics stage, it can predict patient prognosis before surgery. We suggest revising the Silva C criteria by adding perineural invasion as a factor and propose expanding the Silva pattern system to include more histologic variants. It seems that the Silva pattern system can be applied in routine clinical practice to guide EAC therapeutic strategies in the near future.
作为一种新的基于模式的分类方法，Silva 模式系统最近被开发出来，用于评估宫颈内膜腺癌（EAC）的浸润性淋巴结转移和预后。因此，我们进行了这项研究，旨在探索该系统在多机构中国队列中的可重复性和预后意义，目的是对其进行修订和扩展应用。我们回顾性地检查了来自 3 个医疗中心的 191 名 EAC 患者的临床病理数据。Silva 模式系统在 191 名患者中显示出了很好的预后价值、指导治疗选择的意义，以及可接受的可重复性，这些患者包括了额外的组织学变体和 124 例常见型 EAC 患者。总体而言，与常见型 EAC 相比，整个队列在相关临床病理参数方面表现出相似的统计学意义，例如国际妇产科联盟（FIGO）分期（R=0.612 对 R=0.600）、肿瘤厚度（P<0.0001 对 P<0.0001）、淋巴血管侵犯（P<0.0001 对 P<0.0001）、淋巴结转移（P=0.033 对 P=0.018）、神经周围侵犯（P=0.003 对 P=0.001）和无复发生存率（P=0.047 对 P=0.020）。此外，神经周围侵犯与 Silva 模式系统显著相关（P=0.001），并且出现在大多数 Silva C 肿瘤中。总之，Silva 模式系统与 EAC 的生物学行为一致，具有可接受的可重复性。与 FIGO 分期相比，它可以在手术前预测患者的预后。我们建议通过添加神经周围侵犯作为一个因素来修订 Silva C 标准，并提出将 Silva 模式系统扩展到包括更多的组织学变体。Silva 模式系统似乎可以在不久的将来应用于常规临床实践，以指导 EAC 的治疗策略。
