| ObjectiveThis study investigates the Silva staging system for cervical a denocarcinoma,the differences in the clinicopathological features,treatment modalities and prognosis of the three groups of patients with Silva types A,B and C.Through prognostic and survival analysis,the impact of different Silva staging and its clinicopathological features and treatment modalities on the prognosis of cervical a denocarcinoma is investigated,providing a valuable clinical basis for the accurate treatment,reduction of complications and improvement of the quality of survival of cervical a denocarcinoma.MethodsThe cases of patients with histopathologically confirmed cervical a denocarcinoma who underwent surgical treatment fro m January 2014 to December 2019 were retrospectively analyzed in Gansu Provincial Maternal and Child Health Hospital,and all collected pathological sections were re-read by our two senior pathologists according to the Silva staging system,while the patients ’ clinical history data: age,tumor size,squamous cell carcinoma antigen,human papilloma virus(HPV),surgical procedure,adjuvant therapy,etc.and clinical pathology: Federation International of Gynecology and Obstetrics(FIGO)pathological stage,depth of tumour infiltration,lymphatic vascular space infiltration,lymph node metastasis,etc.The data of Silva typing were summarized and collated;SPSS 25.0 software was applied to analyze the correlation between different clinicopathological features and Silva triad,logistic regression was used to analyze the independent influencing factors of Silva typing,and non-parametric K-test was used to compare the two-by-two survival rates among the three groups of Silva typing,and Kaplan-Meier survival analysis,and multifactorial analysis by Log-Rank test,Cox regression model to compare the differences in progression-free survival time and overall survival time by different clinicopathological characteristics.Results1.Of the 105 patients with cervical a denocarcinoma included in the study,the mean age was(4 6.9 ±7.8 1 6)years,with a median age of 4 7 years;HPV infection accounted for 6 8.6 % of the 1 0 5 cases,with HPV type 1 6infection being the most common,with 34 cases(32.4%);Silva typing was the most common,with 72 cases(68.6%),followed by Silva C was the most common type,with 7 2 cases(6 8.6 %),followed by Silva B,with 1 9 cases(18.1%),and Silva A was the least common,with 14 cases(13.3%).2.In the uni variate analysis,FIGO stage,tumour size,depth of tumour infiltration,lymph ovascular interstitial infiltration,pelvic lymph node metastasis and complementary therapy were statistically significant(P < 0.05)when compared with Silva A,B and C components,while age,HPV infection and squamous cell carcinoma antigen status were not statistically significant(P > 0.05)when compared with Silva three types.3.The results of logistic regression multifactor analysis showed that tumour size and depth of tumour infiltration were independent influencing factors for Silva staging of cervical a denocarcinoma,which was statistically significant(P < 0.05),while there was no statistical difference between FIGO stage,lymphatic vascular interstitial infiltration pelvic lymph node metastasis and complementary therapy and Silva staging(P > 0.05).4.Comparison of two-by-two survival rates between Silva typing groups showed that the 3-year progression-free survival rate was 100% for type A,89.47% for type B,and 72.22% for type C.Comparison of progression-free survival rates between groups was statistically significant between type A and type C(P < 0.036),with no statistical significance between type B and both type A and type C(P > 0.05),and the progression-free survival rate was significantly lower for type C than for type A with type B;the 3-year overall survival rate was 1 0 0 % for type A,9 4.7 4 % for type B and 8 1.9 4 % for type C.Comparison of OS between groups showed no statistical significance(P >0.05)and no two-by-two comparison could be made.5.The follow-up time range was 1 2 to 9 5 months,and the median follow-up time was 51 months as of December 2022.22 patients with cervical a denocarcinoma had recurrence or metastasis,14 patients died,and the 1-year progressionfree survival(PFS)rate was 88.6%,the 3-year progressionfree survival rate was 82.9%,and the 1-year overall survival rate(overall survival,OS)97.1%,3-year overall survival rate 86.7%.6.The results of the uni variate survival analysis showed that age,FIGO stage,HPV infection,depth of tumour infiltration,pelvic lymph node metastasis,lymph ovascular interstitial infiltration,Silva staging and surgical method were associated with the survival prognosis of patients with cervical a denocarcinoma;progression-free survival and overall survival of patients with FIGO stage II,depth of tumour infiltration >2/ 3 and laparoscopic surgery were all suggestive of poor prognosis;lymph ovascular interstitial infiltration and Silva staging were associated with poor prognosis.The progression-free survival of patients with interstitial vascular infiltration and Silva C showed poor prognosis,while squamous cell carcinoma antigen,tumour size,pelvic lymph node metastasis and preoperative adjuvant therapy were not statistically associated with survival prognosis of patients with cervical a denocarcinoma(P > 0.0 5).7.Analysis of the results of the multifactorial COX proporti onal risk model showed that age,FIGO stage,mode of surgery and HPV infection were independent risk factors for overall survival and FIGO stage was an independent risk factor for progression-free survival in cervical a denocarcinoma.Conclusion1.The Silva staging system correlated with the FIGO stage,tumour size,depth of tumour infiltration,lymphatic vascular space infiltration and pelvic lymph node metastasis,which is a good predictor of lymph node metastasis and can guide the precise clinical treatment.2.In this study,the Silva staging system correlated with the PFS of patients with cervical a denocarcinoma,and the results showed that patients with Silva C had a poor prognosis,which can guide the clinical decision making for the treatment of patients with cervical a denocarcinoma.3.The Silva staging system allows for better clinical grading of patients and can therefore be combined with a variety of histopathological features to improve the preoperative prediction of Silva staging and more accurate patient staging to select the best surgical approach. |
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