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Pathological classification of desmoplastic reaction is prognostic factor in cervical adenocarcinoma


Desmoplastic reaction (DR) and inflammation are significant pathological manifestations of tumorigenesis in several cancers. However, the correlation between these stromal reactions and cervical adenocarcinoma has been poorly documented. This investigation elucidated whether DR is a prognostic indicator in early cervical adenocarcinoma patients. Fifty-nine patients with early stage cervical adenocarcinoma (stages I/II) were included in the study. DR was divided into three groups, mature, intermediate, and immature, based on the presence of myxoid stroma and hyalinized keloid-like collagen. Inflammatory cell responses were classified as mild, moderate, and severe. Those stromal reactions were separately evaluated in the invasion front stroma and intratumoral stroma. In both the intratumor and invasion front stroma, intermediate/immature DR was correlated with tumor size, T stage, N stage, lymphovascular invasion, and parametrial infiltration (p < 0.001 to p < 0.05). In addition, in the intratumoral stroma, intermediate/immature DR led to short relapse-free survival and overall survival (p < 0.001). In the invasion front stroma, inflammatory cell responses were associated with DR immaturity and FIGO stage (p < 0.01). These results suggest that the classification of DR maturity is a potential prognostic biomarker in early stage cervical adenocarcinoma patients. DR can be evaluated by routine H&E staining without immunohistochemistry, making it convenient and economical in clinical practice.

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The authors acknowledge the funders of this study: JSPS KAKENHI [Grant Numbers JP20K07409 (A.T.), JP20K16196 (K.T.)].

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Authors and Affiliations



TA and AT conceived and designed the study and wrote, edited, and reviewed the manuscript. KT, TA, and TM collected the data and reviewed the manuscript. MM, MT, MI, and SH revised the manuscript. MO and TS conceived and designed the study and reviewed manuscript. All authors approved the final version of the manuscript for publication. TA takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

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Correspondence to Taishi Akimoto or Akira Takasawa.

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The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Ethical approval

The experiments reported here were carried out in agreement with the Declaration of Helsinki and were approved by the Ethics Committee of the Sapporo Medical University Hospital (Sapporo, Japan, IRB study number: 302-197).

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Akimoto, T., Takasawa, A., Takasawa, K. et al. Pathological classification of desmoplastic reaction is prognostic factor in cervical adenocarcinoma. Med Mol Morphol 55, 275–282 (2022).

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  • Desmoplastic reaction
  • Cervical adenocarcinoma
  • Tumor microenvironment
  • Cancer-associated fibroblasts
  • Histopathological prognosticator