Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania.
Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada.
Pathology. 2022 Aug;54(5):548-554. doi: 10.1016/j.pathol.2022.01.007. Epub 2022 Apr 30.
Silva invasion pattern can help predict lymph node metastasis risk in endocervical adenocarcinoma. We analysed Silva pattern of invasion and lymphovascular invasion to determine associations with clinical outcomes in stage IA and IB1 endocervical adenocarcinomas. International Federation of Gynecology and Obstetrics (FIGO; 2019 classification) stage IA-IB1 endocervical adenocarcinomas from 15 international institutions were examined for Silva pattern, presence of lymphovascular invasion, and other prognostic parameters. Lymph node metastasis status, local/distant recurrences, and survival data were compared using appropriate statistical tests. Of 399 tumours, 152 (38.1%) were stage IA [IA1, 77 (19.3%); IA2, 75 (18.8%)] and 247 (61.9%) were stage IB1. On multivariate analysis, lymphovascular invasion (p=0.008) and Silva pattern (p<0.001) were significant factors when comparing stage IA versus IB1 endocervical adenocarcinomas. Overall survival was significantly associated with lymph node metastasis (p=0.028); recurrence-free survival was significantly associated with lymphovascular invasion (p=0.002) and stage (1B1 versus 1A) (p=0.002). Five and 10 year overall survival and recurrence-free survival rates were similar among Silva pattern A cases and Silva pattern B cases without lymphovascular invasion (p=0.165 and p=0.171, respectively). Silva pattern and lymphovascular invasion are important prognostic factors in stage IA1-IB1 endocervical adenocarcinomas and can supplement 2019 International Federation of Gynecology and Obstetrics staging. Our binary Silva classification system groups patients into low risk (patterns A and B without lymphovascular invasion) and high risk (pattern B with lymphovascular invasion and pattern C) categories.
Silva 浸润模式有助于预测宫颈内膜腺癌的淋巴结转移风险。我们分析了 Silva 浸润模式和脉管浸润模式，以确定其与国际妇产科联合会（FIGO；2019 分类）IA 期和 IB1 期宫颈内膜腺癌的临床结局之间的关系。来自 15 个国际机构的 399 例 Silva 模式、脉管浸润存在和其他预后参数的宫颈内膜腺癌进行了检查。使用适当的统计检验比较了淋巴结转移状态、局部/远处复发和生存数据。在 399 例肿瘤中，152 例（38.1%）为 IA 期[IA1，77 例（19.3%）；IA2，75 例（18.8%）]，247 例（61.9%）为 IB1 期。多因素分析显示，脉管浸润（p=0.008）和 Silva 模式（p<0.001）是比较 IA 期和 IB1 期宫颈内膜腺癌的重要因素。总生存与淋巴结转移显著相关（p=0.028）；无复发生存与脉管浸润（p=0.002）和分期（1B1 期与 1A 期）（p=0.002）显著相关。无脉管浸润的 Silva 模式 A 病例和 Silva 模式 B 病例的 5 年和 10 年总生存率和无复发生存率相似（p=0.165 和 p=0.171）。Silva 模式和脉管浸润是 IA1-IB1 期宫颈内膜腺癌的重要预后因素，可补充 2019 年国际妇产科联合会分期。我们的二元 Silva 分类系统将患者分为低风险（无脉管浸润的模式 A 和 B）和高风险（有脉管浸润的模式 B 和模式 C）两类。
