Department of Gynaecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynaecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Eur J Surg Oncol. 2024 Apr;50(4):107977. doi: 10.1016/j.ejso.2024.107977. Epub 2024 Jan 25.
This multicenter study aimed to investigate the disparity in clinical features and prognosis among different histopathologic subtypes of endocervical adenocarcinoma (EA) based on the 2014 World Health Organization (WHO) classification.
We retrieved and analyzed data from the Chinese Four C Database between 2004 and 2018. 672EA patients with radical hysterectomies from 32 institutions were retrospectively reviewed. Clinicopathologic characteristics, five-year overall survival (OS), and disease-free survival (DFS) were compared based on histological subtypes.
The 5-year DFS and OS rates for usual, endometrioid, mucinous, gastric, villoglandular, clear cell/serous/mesonephric EAs were as follows: 81.3 %, 89.1 %, 63.0 %, 35.6 %, 88.6 %, 79.9 %, respectively (P < 0.0001); 87.4 %, 96.6 %, 74.7 %, 34.0 %, 96.7 %, 86.3 %, respectively (P < 0.0001). Gastric- and mucinous-type exhibited a higher frequency of lymph node metastasis, deep stromal invasion, uterine corpus invasion, and recurrence than the usual -type (recurrence rate:50.00 % vs 29.90 % vs 15.50 %, P < 0.0001). Multivariate analysis revealed gastric-type was significantly associated with inferior DFS (HR,3.018; 95 % CI, 1.688-5.397; P < 0.0001) and OS(HR, 4.114; 95 % CI, 2.002-8.453; P < 0.0001). Furthermore, compared to the usual -type, mucinous-type demonstrated significantly worse DFS (HR, 1.773; 95 % CI,1.123-2.8; P = 0.014) and OS (HR, 2.168; 95 % CI,1.214-3.873; P = 0.009) whereas endometrioid-type was an identified as independent factor for better DFS (HR, 0.365; 95 % CI,0.143-0.928; P = 0.034). Villoglandular subtype displayed similar features and favorable prognosis as the usual type.
Relevant clinical features and prognosis varied significantly among histological subtypes of EA, thus offering valuable guidance for the development of subtype-specific treatment strategies to optimize EA management.
本多中心研究旨在根据 2014 年世界卫生组织（WHO）分类，探讨不同组织病理学亚型的宫颈内膜腺癌（EA）的临床特征和预后差异。
我们检索并分析了 2004 年至 2018 年中国四家数据库的数据。回顾性分析了来自 32 家机构的 672 例行根治性子宫切除术的 EA 患者。根据组织学类型比较临床病理特征、5 年总生存率（OS）和无病生存率（DFS）。
普通型、子宫内膜样型、黏液型、胃型、绒毛状-腺体型、透明细胞/浆液/中肾型 EA 的 5 年 DFS 和 OS 率分别为 81.3%、89.1%、63.0%、35.6%、88.6%、79.9%（P<0.0001）；87.4%、96.6%、74.7%、34.0%、96.7%、86.3%（P<0.0001）。胃型和黏液型的淋巴结转移、深肌层浸润、子宫体浸润和复发频率高于普通型（复发率：50.00%比 29.90%比 15.50%，P<0.0001）。多变量分析显示，胃型与较差的 DFS（HR，3.018；95%CI，1.688-5.397；P<0.0001）和 OS（HR，4.114；95%CI，2.002-8.453；P<0.0001）显著相关。此外，与普通型相比，黏液型的 DFS（HR，1.773；95%CI，1.123-2.8；P=0.014）和 OS（HR，2.168；95%CI，1.214-3.873；P=0.009）显著更差，而子宫内膜样型是DFS 更好的独立因素（HR，0.365；95%CI，0.143-0.928；P=0.034）。绒毛状-腺体型与普通型具有相似的特征和良好的预后。
EA 的组织学亚型之间存在显著的临床特征和预后差异，为制定针对特定亚型的治疗策略提供了有价值的指导，以优化 EA 的管理。
