PO.CL09.03 · 临床研究
按Silva模式分层的早期HPV相关宫颈腺癌患者的无复发生存
Recurrence-free survival in patients with early-stage HPV-associated adenocarcinoma of the cervix stratified by Silva patterns
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：与宫颈鳞状细胞癌相比，HPV相关宫颈腺癌在辅助治疗方面存在挑战。基于Silva模式的分类已成为一种组织形态学预测因子，补充了GOG 92中确立的传统Sedlis标准。虽然Silva模式不属于FIGO分期的一部分，但它已被临床指南所考虑，因为Silva模式C带来更高的淋巴结转移和疾病复发风险；然而，其在早期疾病以及不符合Sedlis标准的患者中的预后作用仍不够明确。我们旨在确定早期HPV相关宫颈腺癌患者中，Silva模式C与A/B模式患者之间的无复发生存（RFS）是否存在差异。我们假设Silva模式C可指导Sedlis标准阴性患者的辅助治疗管理。
方法：我们对经手术治疗的FIGO IA-IB2期HPV相关宫颈腺癌患者进行了一项回顾性研究。病例通过我们机构的病理数据库、在经IRB批准的方案下（2015年至2025年）确定。锥切活检和子宫切除术的病理标本由妇科病理学家复审。据此指定Silva模式。临床数据来自电子病历。研究结局是确定RFS，从诊断到复发或至末次随访进行测量。采用Kaplan-Meier分析比较Silva模式A/B与模式C。
结果：我们的样本包括13例HPV相关宫颈腺癌患者。我们确定了6例Silva模式A/B患者和7例Silva模式C患者。3例复发仅发生于Silva模式C组。Silva C组的RFS为42.9%，Silva A/B组为100%（log-rank p值：0.4142）。Silva模式C的中位随访时间为29个月（6-108个月），Silva模式A/B为15个月（0-46个月）。所有复发均发生于不符合Sedlis辅助放疗标准的FIGO IA2-IB1期患者。复发时间分别为10、24和90个月。
结论：Silva模式C患者的RFS较差。所有复发的Silva模式C患者均不符合Sedlis辅助放疗标准。Sedlis标准主要指导鳞状细胞癌的管理；GOG 92患者中仅有12%为腺癌，限制了其在该组中的应用。我们的研究结果提示，Silva模式C可能提供具有临床可操作性的预后信息，并有助于指导有关辅助治疗管理的多学科讨论。有必要在更大规模的队列中对纳入基于Silva模式分类的临床算法进行前瞻性验证。
查看英文原文 English abstract
Background: HPV-associated adenocarcinoma of the cervix presents challenges in adjuvant treatment compared to squamous cell carcinoma of the cervix. Silva Pattern-based classification has emerged as a histomorphologic predictor supplementing the traditional Sedlis Criteria established in GOG 92. While not part of FIGO staging, it is considered in clinical guidelines, as the Silva Pattern C confers a higher risk of nodal metastasis and disease recurrence; however, its prognostic role in early-stage disease and in patients who do not meet Sedlis criteria remains less defined. We aimed to determine whether Recurrence-free survival (RFS) in patients with early-stage HPV-associated adenocarcinoma of the cervix differs between patients with Silva Pattern C and those with A/B. We hypothesize that Silva Pattern C can guide adjuvant management in patients with negative Sedlis Criteria.
Methods: We conducted a retrospective study of patients with surgically treated FIGO Stage IA-IB2 HPV-associated adenocarcinoma of the cervix. Cases were identified through our institutional pathology database under an IRB-approved protocol (2015 to 2025). Pathology specimens from cone biopsies and hysterectomies were reviewed by gynecologic pathologists. Silva patterns were assigned accordingly. Clinical data were obtained from electronic medical records. The study outcome was to determine the RFS, measured from diagnosis to recurrence or to the last follow-up. A Kaplan-Meier analysis was used to compare Silva patterns A/B vs. pattern C.
Results: Our sample consisted of 13 patients with HPV-associated adenocarcinoma of the cervix. We identified 6 patients with Silva Patterns A/B and 7 with Silva Pattern C. Three recurrences occurred exclusively in the Silva Pattern C group. RFS was 42.9% in Silva C and 100% in Silva A/B (log-rank p -value: 0.4142). Median follow-up was 29 months (6-108 months) for Silva Pattern C and 15 months (0-46 months) for Silva Pattern A/B. All recurrences occurred in patients with FIGO stage IA2-IB1 disease who did not meet Sedlis Criteria for adjuvant radiation. Times to recurrence were 10, 24, and 90 months.
Conclusions: Patients with Silva Pattern C experienced worse RFS. None of the patients with Silva Pattern C who recurred met Sedlis criteria for adjuvant radiation. Sedlis criteria mainly guide squamous cell carcinoma management; only 12% of GOG 92 patients had adenocarcinoma, limiting its use for this group. Our findings suggest that the Silva pattern C may provide clinically actionable prognostic information and can help guide multidisciplinary discussions regarding adjuvant management. Prospective validation of clinical algorithms incorporating Silva pattern-based classification in larger cohorts is warranted.
利益披露 Disclosure
A. L. Rosario Santos, None..
H. Bahmad, None..
J. Ravix, None..
A. Pinto, None..
N. Nair, None.