Lyu B J, Shi H Y, Shao Y, Liu Q, Lyu W G
Department of Surgical Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310002, China.
Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310002, China.
Zhonghua Bing Li Xue Za Zhi. 2021 Sep 8;50(9):1014-1019. doi: 10.3760/cma.j.cn112151-20210524-00374.
To investigate the clinicopathological and prognostic significance of International Endocervical Adenocarcinoma Criteria and Classification (IECC) in classifying endocervical adenocarcinomas among Chinese women. 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. 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 (=156, 54.5%) and gastric type (GAC, =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 (<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 (<0.05). Mucinous HPVA showed worse clinical outcomes compared to usual-type HPVA (<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 (<0.05). 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.
探讨国际子宫颈腺癌标准与分类（IECC）在中国女性子宫颈腺癌分类中的临床病理及预后意义。收集了2013年1月至2019年12月在浙江大学医学院附属妇产科医院诊断的286例子宫颈腺癌病例。根据IECC对病例进行回顾和重新分类。将组织学类型与p16免疫染色、人乳头瘤病毒（HPV）mRNA状态、包括国际妇产科联盟（FIGO）分期在内的临床病理参数以及临床随访数据进行关联分析。患者年龄为19至77岁（中位年龄47岁）。FIGO分期为Ⅰ期223例，Ⅱ期22例，Ⅲ期38例，Ⅳ期3例。IECC类型包括213例（74.5%）HPV相关腺癌（HPVA）、60例（21%）非HPV相关腺癌（NHPVA）和13例（4.5%）其他未特指的腺癌（NOS）。HPVA和NHPVA的主要组织学亚型分别为普通型（=156，54.5%）和胃型（GAC，=46，15.9%）。HPVA、NHPVA和腺癌NOS的p16阳性率分别为92%（173/188）、26.6%（17/64）和61.5%（8/13），HPV mRNA原位杂交阳性率分别为89.4%（144/161）、0/18和7/13。与HPVA相比，NHPVA更常与年龄较大、FIGOⅡ-Ⅳ期、神经受累、脉管浸润和p53异常表达相关（<0.05）。单因素生存分析显示，年龄（>47岁）、NHPVA、GAC、FIGOⅡ-Ⅳ期、神经受累、脉管浸润和p53异常表达是总体生存和肿瘤复发较差的指标（<0.05）。黏液性HPVA的临床结局比普通型HPVA更差（<0.01）。多因素生存分析表明，FIGOⅡ-Ⅳ期、NHPVA和p53异常表达是总体生存不良的独立指标，而FIGOⅡ-Ⅳ期和GAC与肿瘤复发独立相关（<0.05）。IECC的两个主要类别，HPVA和NHPVA，不仅在形态学上与病因（HPV感染）相关，而且具有显著的临床病理及预后相关性。
