以Silva模式为基础的分类识别浸润性宫颈内腺癌的低风险病例：系统回顾和荟萃分析

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-05-10 DOI:10.1016/j.gore.2025.101764

Nikita Sinha , Olivia D. Lara , Kimberly Dessources , Emily P. Jones , Leslie H Clark , Russell Broaddus , Benjamin B. Albright

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引用次数: 0

摘要

目的探讨浸润性宫颈内腺癌（EAC）基于Silva模式的分类系统在预测淋巴结（LN）转移、复发和死亡风险方面的区别能力。方法通过基于Silva模式的分类，系统检索PubMed、Scopus和Embase到2024年的EAC患者文献。我们按照Silva模式纳入了报告LN转移、复发或死亡结果的研究。随机效应荟萃分析用于总结二项比例并比较组间结果。结果纳入19项研究，包括2998例患者（20.8%为A型，23.1%为B型，54.1%为C型）。Silva型A病例的淋巴结转移风险显著降低(3/509；0.6%)高于B模式(6.1%；或= 0.33,95% CI 0.16 - -0.67)或模式C (22.0%;or = 0.09；95% ci 0.05-0.16)。在限于I期疾病的5项研究中，没有Silva型A淋巴结转移、复发或死亡病例。在11项报告复发和死亡的研究中，Silva模式A病例的两种结果的风险都明显较低，为0.3%，包括与B/C模式相比，复发（OR = 0.15, 95% CI 0.06-0.34）和死亡（OR = 0.21, 95% CI 0.09-0.50）的风险显著较低。与模式C相比，模式B患者的所有预后风险均显著降低。结论：我们证明Silva分类对EAC的肿瘤预后具有高度预测性，模式A、B和C显示出明显的低、中、高风险特征。A型病例的低风险特征可能证明未来对手术和辅助治疗从目前的标准治疗中降级的前瞻性研究是合理的，而C型病例可能需要考虑辅助治疗的升级。

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Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis

Objective

We aimed to describe the discriminatory ability of the Silva pattern-based classification system for invasive endocervical adenocarcinoma (EAC) in predicting risks of lymph node (LN) metastasis, recurrence, and death.

Method

We systematically searched PubMed, Scopus, and Embase through 2024 for manuscripts describing patients with EAC by Silva pattern-based classification. We included studies reporting outcomes of LN metastasis, recurrence, or death by Silva pattern. Random-effects meta-analysis was used to summarize binomial proportions and compare outcomes between groups.

Results

We identified 19 studies including 2998 patients (20.8 % pattern A, 23.1 % pattern B, 54.1 % pattern C). Silva pattern A cases showed a significantly lower risk of LN metastasis (3/509; 0.6 %) than pattern B (6.1 %; OR = 0.33, 95 %CI 0.16–0.67) or pattern C (22.0 %; OR = 0.09; 95 %CI 0.05–0.16). Across 5 studies limited to stage I disease, there were no Silva pattern A cases with LN metastasis, recurrence, or death. Among 11 studies reporting on recurrence and death, Silva pattern A cases had distinctly low risk of 0.3 % for both outcomes, including a significantly lower risk of recurrence (OR = 0.15, 95 %CI 0.06–0.34) and death (OR = 0.21, 95 %CI 0.09–0.50) versus patterns B/C. Silva pattern B cases showed significantly lower risk of all outcomes compared with pattern C.

Conclusions

We demonstrate that Silva classification is highly predictive of oncologic outcomes for EAC, with patterns A, B, and C showing distinct low, intermediate, and high risk profiles. The low risk profile of pattern A may justify future prospective study of surgical and adjuvant treatment de-escalation from the current standard of care, while pattern C cases may warrant consideration of adjuvant treatment escalation.

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.