Gastric morphology and immunophenotype predict poor outcome in mucinous adenocarcinoma of the uterine cervix
Gastric morphology and immunophenotype predict poor outcome in mucinous adenocarcinoma of the uterine cervix
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DOI：
10.1097/01.pas.0000213434.91868.b0
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发表时间：
2007-05-01
影响因子：
5.6
通讯作者：
Nishimura, Ryuichiro
中科院分区：
文献类型：
--
作者：
Kojima, Atsumi;Mikami, Yoshiki;Nishimura, Ryuichiro
子宫颈内型粘液腺癌（ECA）的子宫颈被定义为一种肿瘤组成的细胞类似的子宫颈内腺，但最近的研究表明，少数ECA显示胃免疫表型。本研究的目的是评估胃表型的意义。本文对53例宫颈粘液腺癌（FIGO IB期37例，IIA期4例，IIB期12例）进行了回顾性分析，并采用新建立的胃型腺癌的形态学鉴别标准进行了重新评价。胃型腺癌的定义是：肿瘤显示透明和/或苍白的嗜酸性和大量的胞浆，有明显的细胞边界。结果与胃免疫表型（通过HIK 1083和MUC 6免疫染色确定）和患者结局相关。根据目前世界卫生组织的方案（2003年），47例肿瘤（89%）被分类为ECA，1例（2%）为肠型，1例（2%）为宫颈内和肠混合型，4例（8%）为微小偏离腺癌。使用新标准重新分类为胃型的47例ECA中的12例（26%）和所有4例最小偏离腺癌，HIK 1083常呈阳性，阳性率为75%（12/16），而非胃肿瘤仅11%（4/37）呈阳性。胃和非胃型肿瘤之间的MUC 6反应性无显著差异（31%，5/16 vs. 16%，6/37; P = 0.4）。胃型腺癌患者的5年疾病特异性生存率显著降低（30 vs. 77%; P < 0.0001），与非胃型相比，胃型腺癌的形态与疾病复发的显著风险相关（P = 0.001; HR，4.5; 95%置信区间，1.42-14.2）。HIK 1083阳性也与5年疾病特异性生存率降低相关（38% vs. 74%; P < 0.005）。具有胃免疫表型的宫颈粘液腺癌可能是一种独特的形态学变异，表现为侵袭性的临床过程。
Endocervical-type mucinous adenocarcinoma (ECA) of the uterine cervix is defined as a tumor composed of cells resembling those of the endocervical glands, but recent studies have demonstrated that a minority of ECAs displays a gastric immunophenotype. The aim of this study was to assess the significance of the gastric phenotype. Fifty-three cases of mucinous adenocarcinoma of the uterine cervix (37 FIGO stage IB, 4 stage IIA, and 12 stage IIB) were reviewed and reevaluated using a newly established morphologic criteria for distinguishing gastric type adenocarcinoma, which was defined as a tumor showing clear and/or pale eosinophilic and voluminous cytoplasm, with distinct cell borders. The results were correlated with gastric immunophenotype, determined by HIK1083 and MUC6 immunostaining, and patient outcome. Following the current World Health Organization scheme (2003), 47 tumors (89%) were classified as ECA, 1 (2%) as intestinal type, 1 (2%) as mixed endocervical and intestinal type, and 4 (8%) as minimal deviation adenocarcinoma. Twelve of 47 (26%) ECAs and all 4 minimal deviation adenocarcinomas, reclassified as gastric type using the novel criteria, were frequently positive for HIK1083 with a rate of 75% (12/16), whereas only 11% (4/37) of nongastric tumors were positive. There was no significant difference in MUC6 reactivity between gastric and nongastric type tumors (31%, 5/16 vs. 16%, 6/37; P = 0.4). Patients with gastric-type adenocarcinomas had a significantly decreased 5-year disease-specific survival rate (30 vs. 77%; P < 0.0001), and the gastric type morphology was related to a significant risk for disease recurrence compared with the nongastric type (P = 0.001; HR, 4.5; 95% confidence interval, 1.42-14.2). HIK1083-positivity was also related to decreased 5-year disease-specific survival rate (38% vs. 74%; P < 0.005). Mucinous adenocarcinoma of the uterine cervix with gastric immunophenotype can be a distinct morphologic variant showing an aggressive clinical course.