Department of Pathology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures.
Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania.
Am J Surg Pathol. 2020 Oct;44(10):1374-1380. doi: 10.1097/PAS.0000000000001485.
Invasive stratified mucinous carcinoma (iSMC) has been suggested to represent an aggressive subtype of endocervical adenocarcinoma. We sought to investigate the outcomes of iSMC and determine which clinical and pathologic parameters may influence the prognosis. Slides from 52 cases of iSMC were collected and classified as follows: pure iSMC (>90% of the entire tumor) and iSMC mixed with other human papillomavirus-associated adenocarcinoma components (miSMC) (>10%, but <90% of the entire tumor). Clinical and pathologic parameters were evaluated and compared with overall survival (OS) and recurrence-free survival (RFS). One third of patients with iSMC presented with lymph node metastases (LNM) and 25% developed local recurrences, whereas 4 (7.7%) developed distant recurrences. 29 cases (55.8%) were pure iSMC, whereas 23 cases (44.23%) were miSMC. OS was 74.7% in pure iSMC versus 85.2% in miSMC (P=0.287). RFS was 56.5% in pure iSMC and 72.9% in miSMC (P=0.185). At 5 years, OS in stage I was 88.9% versus stage II to IV 30% (P=0.004), whereas RFS in stage I was 73.9% versus stage II to IV 38.1% (P=0.02). OS was influenced by International Federation of Gynecology and Obstetrics (FIGO) stage (P=0.013), tumor size (P=0.02), LNM (P=0.015), and local recurrence (P=0.022), whereas RFS was influenced by FIGO stage (P=0.031), tumor size (P=0.001), local recurrence (P=0.009), LNM (P=0.008), and type of surgical treatment (P=0.044). iSMC is an aggressive cervical tumor biologically different from other human papillomavirus-associated adenocarcinomas due to the propensity for LNM, local/distant recurrence. FIGO stage, tumor size, LNM, and presence of local/pelvic recurrences are determinants of outcome in iSMCs.
浸润性柱状黏液腺癌（iSMC）被认为是宫颈内膜腺癌的一种侵袭性亚型。我们旨在研究 iSMC 的结局，并确定哪些临床和病理参数可能影响预后。收集了 52 例 iSMC 的切片，并进行了如下分类：纯 iSMC（整个肿瘤的>90%）和 iSMC 与其他 HPV 相关腺癌成分混合（miSMC）（>10%，但<整个肿瘤的 90%）。评估了临床和病理参数，并与总生存期（OS）和无复发生存期（RFS）进行了比较。三分之一的 iSMC 患者出现淋巴结转移（LNM），25%发生局部复发，而 4 例（7.7%）发生远处复发。29 例（55.8%）为纯 iSMC，23 例（44.23%）为 miSMC。纯 iSMC 的 OS 为 74.7%，miSMC 为 85.2%（P=0.287）。纯 iSMC 的 RFS 为 56.5%，miSMC 为 72.9%（P=0.185）。5 年时，I 期的 OS 为 88.9%，II-IV 期为 30%（P=0.004），而 I 期的 RFS 为 73.9%，II-IV 期为 38.1%（P=0.02）。OS 受国际妇产科联盟（FIGO）分期（P=0.013）、肿瘤大小（P=0.02）、LNM（P=0.015）和局部复发（P=0.022）的影响，而 RFS 受 FIGO 分期（P=0.031）、肿瘤大小（P=0.001）、局部复发（P=0.009）、LNM（P=0.008）和手术治疗类型（P=0.044）的影响。iSMC 是一种侵袭性宫颈肿瘤，由于 LNM、局部/远处复发的倾向，其生物学行为与其他 HPV 相关腺癌不同。FIGO 分期、肿瘤大小、LNM 和局部/盆腔复发的存在是 iSMC 预后的决定因素。
