International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2018
Gastric-Type Adenocarcinoma of the Uterine Cervix: Magnetic Resonance Imaging Features, Clinical Outcomes, and Prognostic Factors.
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Park Kye Jin, Kim Mi-Hyun, Kim Jeong Kon, Cho Kyoung-Sik
Аннотация
OBJECTIVE: Gastric-type mucinous adenocarcinoma (GAS) of uterine cervix has been suggested as distinct clinicopathologic behavior. Our study aimed to investigate the distinguishing imaging features and clinical outcomes of GAS.
METHODS: Fifteen cases of GAS and 45 cases of 3:1 age-matched usual-type endocervical carcinoma (UEA) were assessed. Clinical parameters (age, tumor size, clinical stage, and time to recurrence [TTR] or death) and pathologic results confirmed by surgery were recorded. Imaging features (tumor shape, margin, presence of vaginal involvement, or cyst) on magnetic resonance T2-weighed images were evaluated by consensus reading. Parametrial invasion was assessed by 2 independent readers on a 4-point scale system.
RESULTS: Gastric-type mucinous adenocarcinomas were associated with a higher stage at presentation and higher rates of deep cervical stromal invasion, parametrial invasion, and lymphovascular invasion. On magnetic resonance images, GASs also demonstrated a more infiltrative shape (93.3% vs 22.2%; P < 0.001) with/without cysts, ill-defined margin (93.3% vs 31.8%; P < 0.001), endocervical location (46.7%) or extension to the entire cervix (46.7%), higher rates of vaginal involvement (40.0% vs 4.4%; P = 0.002), and higher grade of parametrial invasion by both readers (66.7% vs 22.2%; P = 0.003) compared with UEAs. Patients with GAS had a significantly shorter TTR compared with UEA cases (P < 0.001) by log-rank test. A multivariate Cox proportional hazards model revealed that an infiltrative tumor shape (hazard ratio, 5.92; P = 0.004) and stage II or greater (hazard ratio, 4.19; P = 0.011) were prognostic indicators of a shorter TTR.
CONCLUSIONS: Gastric-type mucinous adenocarcinoma may have characteristic imaging features and poorer outcomes compared with UEA.
METHODS: Fifteen cases of GAS and 45 cases of 3:1 age-matched usual-type endocervical carcinoma (UEA) were assessed. Clinical parameters (age, tumor size, clinical stage, and time to recurrence [TTR] or death) and pathologic results confirmed by surgery were recorded. Imaging features (tumor shape, margin, presence of vaginal involvement, or cyst) on magnetic resonance T2-weighed images were evaluated by consensus reading. Parametrial invasion was assessed by 2 independent readers on a 4-point scale system.
RESULTS: Gastric-type mucinous adenocarcinomas were associated with a higher stage at presentation and higher rates of deep cervical stromal invasion, parametrial invasion, and lymphovascular invasion. On magnetic resonance images, GASs also demonstrated a more infiltrative shape (93.3% vs 22.2%; P < 0.001) with/without cysts, ill-defined margin (93.3% vs 31.8%; P < 0.001), endocervical location (46.7%) or extension to the entire cervix (46.7%), higher rates of vaginal involvement (40.0% vs 4.4%; P = 0.002), and higher grade of parametrial invasion by both readers (66.7% vs 22.2%; P = 0.003) compared with UEAs. Patients with GAS had a significantly shorter TTR compared with UEA cases (P < 0.001) by log-rank test. A multivariate Cox proportional hazards model revealed that an infiltrative tumor shape (hazard ratio, 5.92; P = 0.004) and stage II or greater (hazard ratio, 4.19; P = 0.011) were prognostic indicators of a shorter TTR.
CONCLUSIONS: Gastric-type mucinous adenocarcinoma may have characteristic imaging features and poorer outcomes compared with UEA.