Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gynecol Oncol. 2022 Nov;33(6):e71. doi: 10.3802/jgo.2022.33.e71. Epub 2022 Aug 9.
The recently updated World Health Organization classification divides endocervical adenocarcinomas (ADCs) into human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) ADCs. This study aimed to investigate the differences in the clinical features and treatment outcomes between patients with HPVA and HPVI.
We retrospectively reviewed the electronic medical records and pathology slides of 123 patients with endocervical ADC who underwent radical hysterectomy and adjuvant radiation therapy. Tumor characteristics, patterns of failure, and survival outcomes were compared between HPVA and HPVI ADCs.
Eighty-one (65.9%) and 42 (34.1%) patients were diagnosed with HPVA and HPVI ADCs, respectively. HPVI ADC showed more frequent positive vaginal resection margin (VRM) and peritoneal seeding than HPVA ADC. After a median follow-up of 58.1 months, local recurrence and distant metastasis were more frequently observed in HPVI ADC than in HPVA ADC. Both local recurrence-free survival (77.3% vs. 91.8%) and distant metastasis-free survival (50.1% vs. 73.7%) rates of HPVI ADC were lower than those of HPVA ADC. Disease-free survival was not significantly different between HPVI and HPVA ADCs.
We demonstrated that HPVI ADC exhibited higher rates of VRM involvement and peritoneal seeding than those of HPVA ADC, resulting in higher rates of local recurrence and distant metastasis. Further studies with larger populations are warranted to explore optimal treatment strategies based on the histological subtypes of endocervical ADC.
世界卫生组织（WHO）最近更新的分类将宫颈内膜腺癌（ADC）分为人乳头瘤病毒（HPV）相关型（HPVA）和 HPV 非相关型（HPVI）。本研究旨在探讨 HPVA 和 HPVI 患者之间临床特征和治疗结果的差异。
我们回顾性分析了 123 例接受根治性子宫切除术和辅助放疗的宫颈内膜 ADC 患者的电子病历和病理切片。比较了 HPVA 和 HPVI ADC 之间的肿瘤特征、失败模式和生存结局。
81 例（65.9%）和 42 例（34.1%）患者被诊断为 HPVA 和 HPVI ADC，HPVI ADC 的阴道切缘阳性（VRM）和腹膜种植的发生率高于 HPVA ADC。中位随访 58.1 个月后，HPVI ADC 的局部复发和远处转移发生率高于 HPVA ADC。HPVI ADC 的局部无复发生存率（77.3% vs. 91.8%）和远处无转移生存率（50.1% vs. 73.7%）均低于 HPVA ADC。HPVI 和 HPVA ADC 之间无疾病生存率无显著差异。
我们发现 HPVI ADC 的 VRM 受累和腹膜种植发生率高于 HPVA ADC，导致局部复发和远处转移的发生率更高。需要进一步进行更大规模的研究，以根据宫颈内膜 ADC 的组织学亚型探索最佳的治疗策略。
