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PR049/#741  Improved risk prediction in HPV-associated endocervical adenocarcinoma through assessment of binary silva pattern-based classification: international multicenter retrospective study of the international society of gynecological pathologists
  1. Aime Powell1,
  2. Anjelica Hodgson2,
  3. Paul A Cohen3,
  4. Joseph Rabban4,
  5. Kay Park5,
  6. W Glenn Mccluggage6,
  7. C Blake Gilks7,
  8. Contributors From The International Society of Gynecological Pathologists (Isgyp)8,
  9. Naveena Singh7 and
  10. Esther Oliva9
  1. 1University of Notre Dame Australia, Institute For Health Research, Fremantle, Australia
  2. 2Toronto General Hospital, Laboratory Medicine Program, Toronto, Canada
  3. 3St John of God Subiaco Hospital and The University of Western Australia, Division of Obstetrics and Gynaecology, Crawley, Perth, Australia
  4. 4University of California San Francisco, Department of Pathology, San Francisico, USA
  5. 5Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, USA
  6. 6Belfast Health and Social Care Trust,, Department of Histopathology, Belfast, UK
  7. 7Vancouver General Hospital, Department of Anatomic Pathology, Vancouver, Canada
  8. 8International Society of Gynecological Pathologists, Isgyp, New York, USA
  9. 9Massachusetts General Hospital, Department of Pathology, Boston, USA


Introduction Endocervical adenocarcinomas (EACs) are neoplasms associated with diverse pathogenesis, morphology, and clinical behavior. The Silva pattern-based classification categorizes HPV-associated EACs based on the morphology of the invasion and predicts lymph node metastasis and recurrence. Traditionally the Silva classification was a three-tier system (pattern A, B, and C). A two-tier/binary system has recently been proposed whereby tumors are classified into low risk (pattern A/pattern B without lymphovascular invasion (LVSI)) and high risk (pattern B with LVSI/pattern C). Our aim was to develop a prognostic model for surgically treated FIGO stage IA2-IB3 EACs that incorporates patient age, LVSI, FIGO stage and three- and two-tier Silva systems.

Methods The International Society of Gynecological Pathologists (ISGyP) established a multicenter consortium to pool de-identified individual patient data for patients with HPV-associated EACs. All participating pathologists completed mandatory online training.

Results Our cohort comprised 792 HPV-associated EACs (table 1). On multivariate analysis a binary Silva system was associated with recurrence-free and disease specific survival (p<0.05) while FIGO 2018 stage I substages were not. In the current three-tiered system, disease specific survival for patients with pattern B tumors did not significantly differ from those with pattern C tumors while those with pattern A tumors did (table 2).

Conclusion/Implications These findings highlight the need for future prospective studies to further investigate the prognostic significance of stage I HPV-associated EAC substaging and the inclusion of the binary Silva pattern of invasion classification, which includes LVSI status, as a component of treatment recommendations.

Abstract PR049/#741 Table 1

Characteristics of the study cohort (n = 792). stratified by pattern of invasion/Silva pattern

Abstract PR049/#741 Table 2

Multivariate (adjusted) competing risk model investigating factors (including the pattern of invasion/Silva pattern as a binary classification system) associated with disease recurrence and disease specific survival for the cohort (n = 792)

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