Real-world utility of Silva pattern in predicting outcomes in cervical adenocarcinoma from a population-based series

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-09-24 DOI:10.1016/j.ygyno.2025.09.006

Tal Milman , Lien Hoang , Jeremy Hamm , Julia Chai , Janice S. Kwon

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引用次数: 0

Abstract

Objective

Silva pattern in cervical adenocarcinoma (AC) is associated with lymph node (LN) involvement. Utility of Silva pattern from diagnostic specimen is uncertain. Our aim was to determine concordance and outcomes for prospectively classified Silva pattern.

Methods

This was a single-centre retrospective study of patients with AC and assigned Silva pattern from 2018 to 2024. The primary outcome was concordance between diagnostic and surgical Silva patterns in cases treated surgically, and false negative (FN) rate of diagnostic Silva A where cases were upgraded to Silva B or C on final pathology. Secondary outcomes were LN involvement, stage, and recurrence for each pattern assessed using Fisher's Exact test.

Results

Of 107 patients, final Silva A, B, and C patterns were identified in 28 (26.2 %), 34 (31.8 %), and 45 (42.1 %), respectively. Among surgical cases, there was significant discrepancy between diagnostic and surgical Silva pattern (p = 0.004). FN rate of diagnostic Silva A was 17.6 %. LN were positive in 0, 1 (3.3 %), and 7 (15.6 %) with patterns A, B, and C (p = 0.032). There were 7 recurrences, including 3 with Silva B and 4 with Silva C (p = 0.032). Stage was significantly different with 0, 4 (11.8 %) and 17 (37.8 %) of Silva A, B, and C patients presenting with stage IB3-IV disease (p < 0.001).

Conclusion

Discrepancy exists between diagnostic and surgical Silva patterns. Caution is advised in using diagnostic Silva pattern to guide treatment, particularly deescalating treatment in case of Silva A. Those with Silva C had significantly higher rates of advance stage, nodal involvement, and recurrences compared to Silva A and B.

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Silva模式在基于人群的系列预测子宫颈腺癌预后中的实际效用

目的：宫颈腺癌（AC）的Silva型与淋巴结（LN）受累有关。诊断标本席尔瓦模式的实用性尚不确定。我们的目的是确定前瞻性分类席尔瓦模式的一致性和结果。方法：这是一项单中心回顾性研究，研究对象为2018年至2024年AC患者，并分配为Silva模式。主要结果是手术治疗病例的诊断和手术席尔瓦模式之间的一致性，以及诊断席尔瓦A的假阴性（FN）率，其中病例在最终病理上升级为席尔瓦B或C。次要结果为使用Fisher’s Exact检验评估的每一种模式的LN累及程度、分期和复发。结果：107例患者中，最终的Silva A、B和C型分别为28例（26.2%）、34例（31.8%）和45例（42.1%）。在手术病例中，诊断型和手术型Silva差异有统计学意义（p = 0.004）。诊断性Silva A的FN率为17.6%。LN分别为0、1（3.3%）和7(15.6%)，模式A、B和C （p = 0.032）。7例复发，其中3例为Silva B， 4例为Silva C （p = 0.032）。IB3-IV期的Silva A、B、C患者分别为0、4（11.8%）和17(37.8%)，分期差异显著(p结论：诊断和手术席尔瓦模式存在差异。建议谨慎使用诊断性Silva模式指导治疗，特别是在Silva A的情况下进行降级治疗。与Silva A和Silva B相比，Silva C患者的晚期、淋巴结累及和复发率明显更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy