ⅠB-ⅡA期宫颈小细胞癌的临床特点和治疗

Clinicopathological features and treatment of early stage small cell cervical carcinoma

目的分析探讨早期期宫颈小细胞癌（SCCC）的临床特点及其治疗和预后，为临床进一步了解SCCC提供帮助。方法对于肿瘤直径大于4cm的患者先行2～3个疗程的新辅助化疗，化疗方案为EP（铂类＋VP16）或VAC（长春新碱＋阿霉素＋环磷酰胺），手术方式为子宫广泛性切除加盆腔淋巴结清扫，如有腹主动脉旁淋巴结肿大则行腹主动脉旁淋巴结切除，术后辅助化疗4～5个疗程，化疗方案仍为EP或VAC，部分患者辅助放疗。结果ⅠB1期10例、ⅠB2期2例、ⅡA期8例，深间质浸润、脉管及淋巴结转移率分别为55％、40％、25％；Syn、NSE、CgA阳性率分别为75％、90％、80％，CerB2、p53阳性率分别为30％、35％。单纯放疗及手术治疗各1例，术前接受新辅助化疗5例，术后辅助化疗3例，辅助放疗或同步放化疗15例。平均随访36个月，11例患者出现淋巴结和远处转移，2、3年生存率分别为75％和50％，平均生存期417个月。结论SCCC以手术治疗为主，但术后深间质浸润、脉管、淋巴转移率高，常早期发生远处转移，预后较差，术后根据具体情况进行相应的放化疗可以一定程度的改善预后。

Objective To evaluate the clinicopathological features, the treatment and prognosis of patients with early stage small cell cervical carcinoma （SCCC）. Methods The clinicopathological data of 20 cases of SCCC （including 10 ⅠB1, 2 ⅠB2 and 8ⅡA） were reviewed. Patients with tumor diameter over 4cm were initially treated with 2 - 3 courses of neoadjuvant chemotherapy （NACT） with EP（etoposide and cisplatin ） or VAC （vinblastine, adriamycin and cytoxan）,then underwent radical hysterectomy and pelvic lymphadenectomy, with or without para-aortic lymphadenectomy followed by adjuvant chemotherapy with EP or VAC for 4 -5 courses, or followed by adjuvant radiation. Results The positive rates of deep stroma invasion, lymphovascular invasion and lymph node metastases was 55% ,40% and 25% respectively. Immunohistologioal staining showed that the positive rates of Syn, NSE and CgA were 75%,90% and 80% respectively, and those of CerB2 and p53 were 30% and 35% respectively. One patient received radical hysterectomy alone and one radiation therapy alone; neoadjuvant chemotherapy was followed by radical surgery in 5; radical surgery followed by adjuvant chemotherapy in 3; and radical surgery followed by adjuvant radiation or chemoradiation in 15. After a median follow-up of 36 months （rang 5 - 110.5months）, 11 cases （55.5%） of the 20 patients had nodal and distant metastases. The 2-year and 3-year overall survival rates for all patients were 75% and 50%, respectively. The median survival duration was 41.7 months. Conclusion Patients with early stage of small cell cervical cancer have a high positive rate of deep stroma invasion, lymphovascular invasion and lymph node metastases with a poor prognosis. Postoperative adjuvant radiation or chemoradiation therapy may be valuable for improving the prognosis.