State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China.
Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA.
Pathology. 2019 Oct;51(6):570-578. doi: 10.1016/j.pathol.2019.04.008. Epub 2019 Aug 21.
A new three-tiered Pattern Classification system for usual-type endocervical adenocarcinomas (U-EACs) recommends using tumour invasive patterns rather than depth of invasion (DOI) and horizontal spread to categorise tumours. Tumours categorised by Pattern Classification are associated with lymph node (LN) metastasis and adverse outcomes. The aim of this study is to further explore the potential of Pattern Classification in surgical pathology practice. A total of 213 consecutive cases [201 U-EACs and 12 gastric-type adenocarcinomas (GACs)] diagnosed between 2006 and 2017 was retrospectively analysed. Clinicopathological data included age at diagnosis, DOI measurement, the status of lymphovascular space invasion (LVSI) and LN metastasis, and the number of LVSI foci, dissected and metastatic LNs. Immunostaining for CD34 and D2-40 was performed to identify LVSI in 14 challenging cases. Overall, mean age at diagnosis was 51 years (range 23-75). LVSI and LN metastasis occurred in 128 (60.1%, 128/213) and 42 (20.5%, 42/205) cases, respectively. Also, 28 (13.1%), 21 (9.9%), and 164 (77.0%) patients had pattern A, B, and C tumours, respectively. Patients with pattern C tumours had the oldest age at diagnosis (p=0.007), the highest incidence of LVSI and LN metastasis, and the highest DOI (p<0.001). Due to a highly heterogeneous growth pattern, pattern C U-EACs were stratified into four subgroups: C1, C2 and C3 corresponded to solid, extensive linear destructive, and band-like lymphocytic infiltrate growth patterns, respectively, and C4 included diffuse destructive, confluent, micropapillary and mixed growth pattern. C2 and C3 subgroup tumours had lower incidence of LVSI (20% and 40%, respectively) than the other two subgroups (p<0.001). None of the patients with C2 and C3 subgroup had LN metastasis and ≥3 LVSI foci. All GACs belonged to pattern C and had deeper stromal invasion (p=0.008), higher incidence of LN metastasis (p=0.001), and larger quantity of LVSI foci (p=0.008) and metastatic LNs (p=0.004) than those of pattern C U-ECAs. Number of LVSI foci were moderately positively correlated with LN metastasis status (p<0.001, γ=0.489) or number of metastatic LNs (p<0.001, γ=0.409). Our study further supports that Pattern Classification is a system easy to follow, which has a strong correlation to LVSI and an effective predictability for LN metastasis. Extensive linear destructive and band-like lymphocytic infiltrate growth patterns in pattern C U-EACs need to be recognised, as they behave less aggressively than that for the other growth pattern subgroups. Our study supports that Pattern Classification can be routinely applied to guide therapies for patients with U-EACs.
一种新的三阶梯式普通型宫颈内膜腺癌（U-EAC）分类系统建议使用肿瘤侵袭模式，而不是浸润深度（DOI）和水平扩散来对肿瘤进行分类。通过分类系统分类的肿瘤与淋巴结（LN）转移和不良预后相关。本研究的目的是进一步探讨分类系统在外科病理学实践中的潜力。共回顾性分析了 2006 年至 2017 年间连续 213 例[201 例 U-EAC 和 12 例胃型腺癌（GAC）]病例。临床病理数据包括诊断时的年龄、DOI 测量、淋巴管血管间隙浸润（LVSI）和 LN 转移的状态以及 LVSI 灶、检出和转移的 LN 的数量。在 14 例具有挑战性的病例中，用 CD34 和 D2-40 免疫组化来识别 LVSI。总体而言，诊断时的平均年龄为 51 岁（范围 23-75）。128 例（60.1%，128/213）和 42 例（20.5%，42/205）发生 LVSI 和 LN 转移，分别为。此外，28 例（13.1%）、21 例（9.9%）和 164 例（77.0%）患者分别患有 A、B 和 C 型肿瘤。患有 C 型肿瘤的患者年龄最大（p=0.007），LVSI 和 LN 转移发生率最高，DOI 最高（p<0.001）。由于生长模式高度异质性，C 型 U-EAC 被分为四个亚组：C1、C2 和 C3 分别对应于实性、广泛线性破坏性和带状淋巴细胞浸润生长模式，C4 包括弥漫破坏性、融合性、微乳头状和混合生长模式。C2 和 C3 亚组肿瘤的 LVSI 发生率（分别为 20%和 40%）低于其他两个亚组（p<0.001）。C2 和 C3 亚组的患者均无 LN 转移和≥3 个 LVSI 灶。所有 GAC 均属于 C 型，其基质浸润更深（p=0.008）、LN 转移发生率更高（p=0.001）、LVSI 灶和转移的 LN 数量更多（p=0.008 和 p=0.004）。LVSI 灶的数量与 LN 转移状态（p<0.001，γ=0.489）或转移性 LN （p<0.001，γ=0.409）之间呈中度正相关。我们的研究进一步支持分类系统是一种易于遵循的系统，它与 LVSI 有很强的相关性，并能有效地预测 LN 转移。C 型 U-EAC 中的广泛线性破坏性和带状淋巴细胞浸润生长模式需要被认识到，因为它们的侵袭性比其他生长模式亚组要低。我们的研究支持分类系统可以常规应用于指导 U-EAC 患者的治疗。
