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Clear Cell Carcinoma (CCC) of the Cervix Is a Human Papillomavirus (HPV)-independent Tumor Associated With Poor Outcome: A Comprehensive Analysis of 58 Cases
The American Journal of Surgical Pathology ( IF 4.5 ) Pub Date : 2022-06-01 , DOI: 10.1097/pas.0000000000001863
Simona Stolnicu 1 , Georgia Karpathiou 2 , Esther Guerra 3 , Claudia Mateoiu 4 , Armando Reques 5 , Angel Garcia 5 , Joost Bart 6 , Ana Felix 7 , Daniela Fanni 8 , Joao Gama 9 , David Hardisson 10, 11, 12 , Jennifer A Bennett 13 , Carlos Parra-Herran 14 , Esther Oliva 15 , Nadeem Abu-Rustum 16 , Robert A Soslow 17 , Kay J Park 17
Affiliation  

Cervical clear cell carcinoma (CCC) is a rare human papillomavirus–independent adenocarcinoma. While recent studies have focused on gastric-type endocervical adenocarcinoma (GTA), little is known about CCC. A total of 58 (CCCs) were collected from 14 international institutions and retrospectively analyzed using univariable and multivariable methods and compared with 36 gastric-type adenocarcinomas and 173 human papillomavirus–associated (HPVA) endocervical adenocarcinoma (ECA) regarding overall survival (OS) and recurrence-free survival (RFS). Most cases were FIGO stage I (72.4%), with Silva C pattern of invasion (77.6%), and the majority were treated with radical surgery (84.5%) and adjuvant therapy (55.2%). Lymphovascular invasion was present in 31%, while lymph node metastasis was seen in 24.1%; 10.3% were associated with abdominopelvic metastases at the time of diagnosis; 32.8% had recurrences, and 19% died of disease. We did not find statistically significant differences in OS and RFS between CCC and GTA at 5 and 10 years (P=0.313 and 0.508, respectively), but there were significant differences in both OS and RFS between CCC and HPVA ECA (P=0.003 and 0.032, respectively). Also, OS and RFS in stage I clear cell and GTA were similar (P=0.632 and 0.692, respectively). Multivariate analysis showed that OS is influenced by the presence of recurrence (P=0.009), while RFS is influenced by the FIGO stage (P=0.025). Cervical CCC has poorer outcomes than HPVA ECA and similar outcomes to human papillomavirus–independent GTA. Oncologic treatment significantly influences RFS in univariate analysis but is not an independent prognostic factor in multivariate analysis suggesting that alternative therapies should be investigated.



中文翻译:

宫颈透明细胞癌 (CCC) 是一种与人乳头瘤病毒 (HPV) 无关的肿瘤,与预后不良相关:58 例病例的综合分析

宫颈透明细胞癌(CCC)是一种罕见的不依赖人乳头瘤病毒的腺癌。虽然最近的研究集中在胃型宫颈内膜腺癌 (GTA),但对 CCC 知之甚少。从 14 个国际机构收集了总共 58 例 (CCC),使用单变量和多变量方法进行回顾性分析,并与 36 例胃型腺癌和 173 例人乳头瘤病毒相关 (HPVA) 宫颈腺癌 (ECA) 的总生存期 (OS) 和无复发生存期(RFS)。大多数病例为FIGO I期(72.4%),Silva C型浸润(77.6%),大多数接受根治性手术(84.5%)和辅助治疗(55.2%)。31%有淋巴管侵犯,24.1%有淋巴结转移;10.3% 在诊断时与腹盆腔转移相关;32.8%出现复发,19%死于疾病。我们没有发现 CCC 和 GTA 之间 5 年和 10 年的 OS 和 RFS 存在显着差异(分别为P = 0.313 和 0.508),但 CCC 和 HPVA ECA 之间的 OS 和 RFS 存在显着差异(P = 0.003 和0.032,分别)。此外,I 期透明细胞和 GTA 中的 OS 和 RFS 相似(分别为P = 0.632 和 0.692)。多变量分析显示,OS 受复发的影响 ( P = 0.009),而 RFS 受 Figo 分期的影响 ( P = 0.025)。宫颈 CCC 的结果比 HPVA ECA 差,但与不依赖人乳头瘤病毒的 GTA 的结果相似。在单变量分析中,肿瘤治疗显着影响 RFS,但在多变量分析中并不是独立的预后因素,表明应研究替代疗法。

更新日期:2022-05-31
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