Silva分型在HPV相关性子宫颈腺癌及原位腺癌中的应用及临床意义

Application and clinical significance of Silva typing system in adenocarcinoma in situ and endocervical adenocarcinoma with HPV-assciated

目的探讨Silva分型在HPV相关性子宫颈腺癌(HPV-associated endocervical adenocarcinoma,HPVA)及原位腺癌(adenocarcinoma in situ,AIS)中的应用及临床意义。方法回顾性分析78例HPVA及AIS的镜下形态,应用Silva分型标准重新分类,比较不同Silva型别及AIS的临床病理学特征,分析不同侵袭模式与预后的相关性。结果患者年龄28~72岁,平均(44.9±9.2)岁,随访时间2~47个月,中位时间为17个月,均未见病变复发。78例中AIS 37例(47.4%,37/78),HPVA 41例(52.6%,41/78),其中Silva A型18例(43.9%,18/41)、B型12例(29.3%,12/41)、C型11例(26.8%,11/41)。不同Silva型别组间的临床分期、淋巴脉管侵犯、淋巴结转移、神经侵犯、术后放化疗差异均有统计学意义(P<0.05);肿瘤厚度与宽度组间比较(除AIS与Silva A型的肿瘤宽度、Silva A型与B型的肿瘤厚度和宽度),差异均有统计学意义(P<0.05)。AIS、Silva A型腺癌锥切标本的病变符合率明显高于活检标本(97.4%和68%、93.3%和40%)。结论Silva分型模式与HPVA临床分期、淋巴脉管侵犯、淋巴结转移、神经侵犯、术后放化疗密切相关。Silva两级分类模式可以更好地筛选非破坏性生长的子宫颈腺癌(AIS/Silva A型);若锥切标本切缘阴性,建议随访观察,其他类型也可制定个性化的处理方案,避免过度治疗。

Purpose To investigate the application and clinical significance of Silva typing system in adenocarcinoma in situ and endocervical adenocarcinoma assciated with HPV infection.Methods A total of 78 cases of HPV associated endocervical adenocarcinoma and adenocarcinoma in situ were reviewed,and divided into patterns A,B and C according to Silva system criteria.Their clinicopathological parameters were retrospectively studied.The prognosis of patients with adenocarcinoma in situ and different invasion modes of cervical adenocarcinoma was analyzed by Silva typing system.Results The average age of patients was(44.9±9.2)years(ranged 28-72 years).The median follow-up time was 17 months(ranged 2-47 months)and no recurrence was found.Among the 78 patients,37 cases(47.4%,37/78)were AIS,41 cases(52.6%,41/78)were HPVA,18 cases of Silva type A(43.9%,18/41),12 cases of type B(29.3%,12/41)and 11 cases of type C(26.8%,11/41).Statistical data demonstrated that Silva pattern system was closely correlated with clinicopathological parameters,such as clinical stage,LVSI,LN metastasis,PNI and postoperative adjuvant chemotherapy and radiotherapy(P>0.05).There were statistically significant differences in tumor depth and horizontal spread among different Silva types(except for the horizontal spread between AIS and Silva type A or the tumor depth and horizontal spread between Silva types A and B).Conization was significantly higher than biopsy in the coincidence rate of the final diagnosis of AIS or Silva type A(97.4%and 68%,93.3%and 40%).Conclusion Silva pattern system is closely correlated with clinical stage,LVSI,LN metastasis,PNI and postoperative adjuvant chemotherapy and radiotherapy of HPVA.Two-level classification of Silva typing system can better screen the endocervical adenocarcinoma with non-destructive growth(AIS/Silva type A),if the cutting edge of conization specimen is negative,follow-up observation is recommended for other types,and personalized treatment scheme can also be developed to avoid over treatment.