Dados do Resumo

Título

Clinical, pathological and molecular characterization of invasive cervical adenocarcinomas

Introdução

Cervical cancer is the fourth most common neoplasm in women worldwide with endocervical adenocarcinoma (EA) accounting for 10 to 25% of cervical carcinomas. The latest edition of WHO (2020) classifies the EA into human papillomavirus (HPV)-associated adenocarcinomas (HPVAs) and non-HPV-associated adenocarcinomas (NHPVAs), also incorporating a new stratification system of patients with usual type HPVAs into risk categories based on the pattern of stromal invasion (Silva system). Although different histological types have been recognized for a long time, changes in the expression pattern of DNA repair genes, HER2 and PD-L1 for this type of neoplasm have not yet been defined.

Objetivo

The present study aims to stratify cases of AEs into risk categories according to the Silva system, reclassify according to the guidelines of WHO ed. 2020, as well as to establish the immunohistochemical expression pattern of DNA repair proteins, p16, HER2 and PD-L1.

Métodos

This is a retrospective cohort study with about 104 patients with cervical adenocarcinoma submitted to surgical treatment at the A.C.Camargo Cancer Center, São Paulo/SP, from 2002 to 2022. After the review morphological, DNA repair gene proteins, p16, HER2 and PD-L1 were conducted through immunohistochemical study on a paraffin tissue microarray slide. These slides were analyzed to determine which cases had loss of expression of the repair proteins and which were positive for p16, HER2 and PD-L1. The results will be presented in terms of frequency in tables and graphs. Continuous variables will be presented as medians, and categorical variables will be presented as absolute frequencies and percentages. Statistical analysis will be performed using SPSS 23.0 for Windows. Survival analyses will be conducted using the Kaplan-Meier method with the log-rank test for calculation.

Resultados

Of the 104 eligible cases of invasive endocervical adenocarcinoma, 40 cases have been reviewed so far. These were classified as HPV-related or not related and evaluated for histological subtype, angiolymphatic invasion, and Silva invasion pattern. Regarding the etiological classification of the tumors, HPV-associated adenocarcinomas were the most common (39 cases - 97.5%), among which the usual histological subtype was predominant (34 cases - 87.2%), followed by intestinal mucinous (2 cases - 5.1%), invasive mucinous stratified carcinoma - iSMC - (2 cases - 5.1%), and mucinous NOS (1 case - 2.6%). Among the non-HPV-associated adenocarcinomas, only one gastric subtype was found (2.5%). Among the usual adenocarcinomas, 2 cases (5.9%) had pattern A. Pattern B was observed in 10 cases (29.4%), and pattern C was found in 22 cases (64.7%). Lymphovascular invasion was present only in patterns C (3 cases) and in one case of iSMC. The remaining cases are being analyzed.

Conclusões

These data provide the frimework for future studies with regard to the influence of classification system of invasive endocervical adenocarcinomas by pattern of invasion rather than depth of invasion, identificando patients who do not require lymph node resection at the time of definitive surgery and have excelente prognosis (Pattern A).

Financiador do resumo

The authors received no specific funding for this work

Palavras Chave

endocervical adenocarcinoma; risk stratification; imunohistochemistry