Stromal invasion pattern identifies patients at lowest risk of lymph node metastasis in HPV-associated endocervical adenocarcinomas, but is irrelevant in adenocarcinomas unassociated with HPV Journal Article

   

Authors:	Stolnicu, S.; Barsan, I.; Hoang, L.; Patel, P.; Terinte, C.; Pesci, A.; Aviel-Ronen, S.; Kiyokawa, T.; Alvarado-Cabrero, I.; Oliva, E.; Park, K. J.; Abu-Rustum, N. R.; Pike, M. C.; Soslow, R. A.
Article Title:	Stromal invasion pattern identifies patients at lowest risk of lymph node metastasis in HPV-associated endocervical adenocarcinomas, but is irrelevant in adenocarcinomas unassociated with HPV
Abstract:	Objective: The Silva invasion pattern-based classification system stratifies endocervical adenocarcinomas (ECAs) into 3 categories corresponding to risk of metastasis and recurrence, but has only been evaluated for HPV-associated ECAs of usual type. We examined whether the Silva system is applicable to all endocervical adenocarcinomas, especially those not associated with HPV. Methods: Complete slide sets from 341 surgical specimens of ECA were collected from 7 institutions worldwide. All specimens were associated with clinical records covering at least 5 years of follow-up. Tumors were classified as HPV-associated (HPVA) or not (NHPVA) by both morphology and detection of HPV using in situ hybridization. Recurrence and survival were analyzed by multivariate Mantel-Haenszel methods. Results: Most specimens (292; 85.6%) were HPVA, while 49 (14.3%) were NHPVA. All NHPVAs were Silva pattern C, while 76.0% of HPVAs were pattern C, 14.7% pattern A, and 9.3% pattern B. Including both HPVAs and NHPVAs, lymphovascular invasion (LVI) was detected in 0% of pattern A, 18.5% of pattern B and 62.6% of pattern C cases (p < 0.001). None of the pattern A or B cases were associated with lymph node metastases (LNM), in contrast to pattern C cases (21.8%). Among patients with Silva pattern C ECA, those with HPVA tumors had a lower recurrence rate and better survival than those with NHPVA; however, when adjusted for stage at diagnosis, the difference in recurrence and mortality was small and not statistically significant. Conclusions: Application of the Silva system is only relevant in HPVA cervical adenocarcinoma. © 2018 Elsevier Inc.
Keywords:	metastasis; recurrence; pathology; cervical cancer; human papillomavirus; lymphovascular invasion
Journal Title:	Gynecologic Oncology
Volume:	150
Issue:	1
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2018-07-01
Start Page:	56
End Page:	60
Language:	English
DOI:	10.1016/j.ygyno.2018.04.570
PROVIDER:	scopus
PUBMED:	29859673
PMCID:	PMC6615482
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85047616085&doi=10.1016%2fj.ygyno.2018.04.570&partnerID=40&md5=a5601566ac125da41d9fe0972d852ed8
Notes:	Article -- Export Date: 2 July 2018 -- Source: Scopus

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