Endocervical Adenocarcinoma – Proposal for a New Pattern-Based Classification System with Significant Clinical Implications: A Multi-Institutional Study
Kay J Park, Isabel Alvarado-Cabrero, Golnar Rasty, Sung R Hong, Jose G Chanona-Vilchis, Andrea Diaz De Vivar, Brent Arville, Denise A Barbuto, Joanne KL Rutgers, Andres A Roma, Rouba Ali-Fehmi, Farah Tabassum, Norihiro Teramoto, Yoshiki Mikami, Elvio G Silva. MSKCC, New York; Mexican Oncology Hosp, Mexico City, Mexico; Univ Health Network, Toronto, Canada; Kwangdong Univ, Seoul, Korea; Inst Nacional de Cancerologia, Mexico City, Mexico; MDACC, Houston; Cedars Sinai Med Cnt, Los Angeles; Long Beach Memorial Hosp, Irvine; Cleveland Clinic, Cleveland; Wayne State, Detroit; Shikoku Cancer Cnt, Ehime, Japan; Kyoto Univ, Kyoto, Japan
Background: The treatment of endocervical adenocarcinoma (EAC) is largely based on tumor depth of invasion (DOI); however, this crucial prognostic parameter is pathologically difficult to measure accurately or consistently. Greater than 95% of lymph nodes (LN) resected in EAC are negative, yet such aggressive LN dissections cause significant morbidity without obvious clinical benefit to patients, many of whom are at a young age. Therefore, we investigated other pathologic parameters that may better identify patients at risk of developing LN metastases.
Design: Cases diagnosed and treated as EAC from 12 institutions were reviewed. Clinical information and pathologic features were assessed, including: DOI, tumor size, LVI and pattern of tumor invasion using a newly devised system, defined as follows:
Pattern A = well-demarcated glands, regardless of DOI
Pattern B = early stromal invasion arising from well-demarcated glands
Pattern C = diffuse, destructive invasion
Results: 360 cases were identified (stage IA1 to IVB). Ages ranged from 20 to 83 years (mean 44.9) and DOI ranged from 0.5 to >40mm (mean 7.7mm). LVI was present in 145 cases.
Table 1 shows outcome data comparing the standard method of tumor evaluation (DOI) vs. the newly proposed pattern-based method:
|Patients||Patients with Pos LN||Total LN||# Pos LN||Stage I||Stage II-IV|
|Standard Method||360||53 (15%)||8187||83 (1%)||327 (91%)||33 (9%)|
|Pattern A||79 (22%)||0||1651||0||79 (100%)||0|
|Pattern B||91 (25%)||7 (8%)||2153||11 (0.5%)||89 (98%)||2 (2%)|
|Pattern C||190 (53%)||46 (24%)||4383||72 (2%)||157 (83%)||33 (17%)|