以浸润模式为基础的新的风险分层体系在宫颈HPV相关性腺癌中的应用

Application of a new risk stratification system based on infiltration pattern in cervical HPV related adenocarcinoma

目的:探讨以浸润模式为基础的新的风险分层体系在宫颈HPV相关性腺癌中的应用及临床意义。方法:收集首都医科大学附属北京妇产医院2016年6月至2019年11月诊断的宫颈腺癌病例。经过筛选,共入组54例HPV相关性腺癌。采用以Silva分型为基础的新的风险分层体系,将54例HPV相关性腺癌分为Pattern A、Pattern B和Pattern C三种亚型,并分析各亚型的临床病理特征。结果:在54例宫颈HPV相关性腺癌中,Pattern A 17例(31.5%),Pattern B 10例(18.5%),Pattern C 27例(50.0%)。17例Patter n A均为I期,所有病例未见淋巴管脉管间隙浸润(lymphatic vascular space invasion,LVSI)及淋巴结转移,10例Pattern B均为Ⅰ期,1例可见LVSI,所有病例未见淋巴结转移。27例Pattern C包括Ⅰ期15例、Ⅱ期6例、Ⅲ期6例,10例(37.0%)可见LVSI,6例伴有淋巴结转移。54例HPVA患者的FIGO分期与各Pattern分型的差异具有统计学意义(χ^(2)=15.172,P<0.001)。在浸润深度方面,Pattern A和Pattern C的差异有统计学意义(χ^(2)=9.279,P=0.005)。在LVSI方面,Pattern A和Pattern C的差异有统计学意义(χ^(2)=17.443,P<0.001)。在淋巴结转移率方面,Pattern A和Pattern C的差异有统计学意义(χ^(2)=10.004,P=0.002)。结论:以浸润模式为基础的新的风险分层体系应用到HPVA的病理诊断中,提高了早期HPVA诊断的一致性,可以很好地分流早期HPVA患者。Pattern A很少有淋巴结转移,可以采取更加保守的治疗,免于盆腔淋巴结清扫术,提高生活质量。Pattern C需要采取更加积极的治疗。Pattern B的治疗选择还需更进一步的研究。与FIGO分期相比,以浸润模式为基础的新的风险分层体系,能够更加个体化地指导HPV,尤其是Pattern A相关性腺癌患者的治疗。

Objective:To explore the application and clinical significance of a new risk stratification system based on infiltration pattern in cervical HPV related adenocarcinoma.Methods:Cases of cervical adenocarcinoma diagnosed in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from June 2016 to November 2019 were collected.After screening,54 patients with HPV related adenocarcinoma were enrolled.According to a new risk stratification system based on the Silva classification,the 54 patients with HPV related adenocarcinoma were divided into Pattern A,Pattern B and Pattern C,and their clinicopathological characteristics were analyzed.Results:Among 54 patients with HPV related adenocarcinoma,17 patients were Pattern A(31.5%),10 patients were Pattern B(18.5%),27 patients were Pattern C(50.0%);17 patients with Pattern A were all stage Ⅰ.No lymphatic vascular space infiltration(LVSI)or lymph node metastasis was found in all patients;10 patients with Pattern B were all stage Ⅰ.LVSI was found in 1 patient,and no lymph node metastasis was found in all patients;27 patients with Pattern C included 15 patients in stage Ⅰ,6 patients in stage Ⅱ and 6 patients in stage Ⅲ.LVSI was found in 10 patients(37.0%)and lymph node metastasis in 6 patients.There was significant difference between FIGO stage and pattern typing in 54 patients with HPV related adenocarcinoma(χ^(2)=15.172,P<0.001).In depth of invasion,Pattern A and C were significantly different(χ^(2)=9.279,P=0.005).In LVSI,the difference between Pattern A and C was statistically significant(χ^(2)=17.443,P<0.001).In lymph node metastasis rate,Pattern A and Pattern C were significantly different(χ^(2)=10.004,P=0.002).Conclusion:The new risk stratification system based on infiltration model can be applied to the pathological diagnosis of HPV related adenocarcinoma,improve the consistency of early diagnosis of HPV related adenocarcinoma,and can well shunt early HPV related adenocarcinoma patients.Pattern A has little lymph node metastasis,so it can take more conservative treatment,avoid pelvic lymphadenectomy,and improve the quality of life.Pattern C needs to be treated more actively.The treatment choice of Pattern B needs further study.In general,compared with FIGO stage,especially Pattern A,the new risk stratification system based on infiltration pattern can be more individualized to guide the treatment of HPV related adenocarcinoma patients.