Cervical adenocarcinoma risk stratification using histotype and invasion pattern: a multicenter retrospective study...

Area of Science:

• Gynecology
• Oncology
• Pathology

Background:

• Cervical adenocarcinoma risk stratification is crucial for treatment decisions.
• The Silva classification, based on invasion patterns, aims to categorize HPV-associated adenocarcinoma (HPVA).
• The prognostic role of HPV-independent adenocarcinoma (HPVI) relative to HPVA requires clarification.

Purpose of the Study:

• To validate the clinical utility of the Silva classification in a Japanese cohort.
• To assess the prognostic value of HPV-associated adenocarcinoma (HPVA) and HPV-independent adenocarcinoma (HPVI).
• To compare the Silva classification with tumor size for risk stratification.

Main Methods:

• Retrospective analysis of 264 FIGO stage I-II cervical adenocarcinoma cases.
• Classification into HPVA (low-risk/high-risk via Silva) and HPVI.
• Evaluation of lymph node metastasis, disease-free survival (DFS), and overall survival (OS).

Main Results:

• Low-risk HPVA (27%) had 0% lymph node metastasis and excellent survival (5-yr DFS 98%, OS 100%).
• High-risk HPVA (49%) showed 12% metastasis and lower survival (5-yr DFS 83%, OS 97%).
• HPVI (23%) exhibited 38% metastasis and poorest survival (5-yr DFS 53%, OS 63%). Multivariable analysis confirmed Silva classification and HPVI as independent prognostic factors.

Conclusions:

• The three-tier system (histotype + Silva classification) is superior to tumor size for prognostic stratification.
• Low-risk HPVA demonstrates favorable outcomes, supporting conservative management options like uterine preservation.
• The Silva classification provides valuable prognostic information for cervical adenocarcinoma.