目的:这项多中心研究旨在根据2014年世界卫生组织(WHO)分类,调查不同组织病理学亚型宫颈腺癌(EA)的临床特征和预后差异。
方法:我们从中国四C数据库中检索并分析了2004年至2018年的数据。回顾性分析了来自32个机构的672EA根治性子宫切除术患者。临床病理特征,5年总生存期(OS),根据组织学亚型比较无病生存率(DFS)。
结果:通常的5年DFS和OS费率,子宫内膜样,粘液,胃,滑膜腺体,透明细胞/浆液/中肾EAs如下:81.3%,89.1%,63.0%,35.6%,88.6%,79.9%,分别为(P<0.0001);87.4%,96.6%,74.7%,34.0%,96.7%,86.3%,分别为(P<0.0001)。胃和粘液性型表现出更高的淋巴结转移频率,深层基质侵入,子宫体侵犯,和复发比通常类型(复发率:50.00%vs29.90%vs15.50%,P<0.0001)。多因素分析显示胃型与下DFS显著相关(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)。此外,与通常的类型相比,黏液型表现出明显更差的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),而子宫内膜样类型是改善DFS的独立因素(HR,0.365;95%CI,0.143-0.928;P=0.034)。颈腺体亚型表现出与通常类型相似的特征和良好的预后。
结论:EA的组织学亚型之间的相关临床特征和预后差异显着,从而为优化EA管理的亚型特异性治疗策略的开发提供有价值的指导.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.