Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Department of Surgical Pathology, Women's Hospital and Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Pathology. 2022 Aug;54(5):555-562. doi: 10.1016/j.pathol.2021.12.301. Epub 2022 Mar 26.
The new World Health Organization (WHO) classification of tumours of the female genital tract (2020) divides endocervical adenocarcinoma (EAC) into human papilloma virus (HPV)-related adenocarcinoma (HPVA) and HPV-independent adenocarcinoma (HPVI) to underscore the morphological and pathogenetic correlation. It may be potentially prognostic. In this study, we appraised the new WHO classification in an independent, single institution-based EAC cohort from China to assess the clinicopathological features and prognostic value among tumour types. Our study cohort contained 402 consecutive, surgically excised EACs consisting of 298 (74.1%) HPVA, 88 (21.9%) HPVI and 16 (4%) adenocarcinomas not otherwise specified (NOS). Usual-type (55.7%) and gastric-type adenocarcinoma (GAC) (18.2%) was the most common type in HPVA and HPVI, respectively. Block p16 staining (94.7% vs 24.4%) and HPV mRNA signal (89.4% vs 0) were more common in HPVA than in HPVI (p<0.001). HPVI or GAC were more frequently associated with prognostically adverse variables including old age, large tumour size, deep invasion of the cervical wall, high tumour stage, spread of the upper genital tract, lymphovascular invasion, and mutant-type p53 expression, compared to HPVA or mucinous/usual-type HPVA, respectively (all p<0.001). In univariate survival analysis, HPVI had a worse overall survival and higher tumour recurrence compared to HPVA (p<0.05). Mucinous-type HPVA showed a worse prognosis than usual-type HPVA, but better than GAC (p<0.001). Multivariate survival analysis demonstrated that HPVI was independently associated with a worse overall survival and tumour recurrence (p<0.05) while GAC was an adverse prognostic factor independently of FIGO stage (p<0.05). Our findings validate the value of the new WHO classification in prognostic stratification and pathogenetic correlation in EAC and its subtypes.
新的世界卫生组织（WHO）女性生殖器官肿瘤分类（2020 年）将宫颈内腺癌（EAC）分为人乳头瘤病毒（HPV）相关腺癌（HPVA）和 HPV 无关腺癌（HPVI），以强调形态学和发病机制的相关性。它可能具有潜在的预后意义。在这项研究中，我们在一个独立的、基于单一机构的中国 EAC 队列中评估了新的 WHO 分类，以评估肿瘤类型之间的临床病理特征和预后价值。我们的研究队列包括 402 例连续手术切除的 EAC，其中 298 例（74.1%）为 HPVA，88 例（21.9%）为 HPVI，16 例（4%）为未另作特殊说明的腺癌（NOS）。普通型（55.7%）和胃型腺癌（GAC）（18.2%）分别是 HPVA 和 HPVI 中最常见的类型。HPVA 中更常见的是弥漫性 p16 染色（94.7%比 24.4%）和 HPV mRNA 信号（89.4%比 0），而 HPVI 中更常见的是弥漫性 p16 染色（94.7%比 24.4%）和 HPV mRNA 信号（89.4%比 0）。与 HPVA 或黏液性/普通型 HPVA 相比，HPVI 或 GAC 更常与预后不良的变量相关，包括年龄较大、肿瘤较大、宫颈壁深层浸润、肿瘤分期较高、上生殖道扩散、脉管侵犯和突变型 p53 表达（均 p<0.001）。在单因素生存分析中，与 HPVA 相比，HPVI 的总生存率和肿瘤复发率较低（p<0.05）。黏液型 HPVA 的预后比普通型 HPVA 差，但比 GAC 好（p<0.001）。多因素生存分析表明，HPVI 是总生存率和肿瘤复发的独立预后因素（p<0.05），而 GAC 是独立于 FIGO 分期的不良预后因素（p<0.05）。我们的研究结果验证了新的 WHO 分类在 EAC 及其亚型中的预后分层和发病机制相关性方面的价值。
