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

S. Stolnicu, I. Barsan, L. Hoang, P. Patel, C. Terinte, A. Pesci, S. Aviel-Ronen, T. Kiyokawa, I. Alvarado-Cabrero, E. Oliva, K. J. Park, N. R. Abu-Rustum, M. C. Pike, R. A. Soslow

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34 Scopus citations

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.

Original languageEnglish
Pages (from-to)56-60
Number of pages5
JournalGynecologic Oncology
Volume150
Issue number1
DOIs
StatePublished - Jul 2018
Externally publishedYes

Keywords

  • Cervical cancer
  • Human papillomavirus
  • Lymphovascular invasion
  • Metastasis
  • Pathology
  • Recurrence

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