宫颈小细胞癌14例临床分析

Clinical analysis of cervical small cell carcinoma in 14 cases

目的分析宫颈小细胞癌的临床特点、治疗和预后影响因素。方法回顾性分析自2006年4月至2012年3月间于北京协和医院治疗的14例宫颈小细胞癌患者的临床资料,记录人口统计学信息、诊断及治疗信息,并记录随访及生存资料。结果 14例患者的中位年龄为38岁(26～66岁),其中13例患者为育龄期妇女,1例为绝经后。14例患者中FIGO分期Ⅰb1期为5例,Ⅰb2期3例,Ⅱa2期1例,Ⅱb期2例,Ⅳb期3例。分期为Ⅰb1-Ⅱa2的9例患者及1例Ⅱb期患者经先期化疗后,接受了根治性子宫切除术±双附件切除术+盆腔(和/或腹主动脉旁)淋巴结清扫术,1例Ⅳb期患者行开腹全子宫切除术。所有患者均接受了以顺铂为主的化疗。4例Ⅰb1-Ⅱa2期的患者于子宫根治性手术后接受辅助盆腔放疗,1例Ⅱb期及1例Ⅳb期患者接受了根治性盆腔放疗。14例患者随访时间3～51个月。Ⅰb1-Ⅱa2期的9例患者中,7例患者无瘤生存,2例分别于随诊10个月和9个月时发生肺转移。Ⅱb期-Ⅳb期的5例患者中,1例Ⅱb期患者随访19个月时盆腔复发,另4例患者死亡,总生存期5～12个月。结论宫颈小细胞癌是一种恶性程度极高的神经内分泌癌,容易早期发生远处转移,预后极差,治疗应采用包括手术、放疗和化疗的综合治疗模式。

Objective To evaluate the relative clinical characteristics, therapy and prognosis of cervical small cell carcinoma. Methods Fourteen patients diagnosed with cervical small cell carcinoma were treated at Peking Union Medical College Hospital （PUMCH） from Apr, 2006 to Mar, 2012. The demographic, treatment and survival information were retrospectively reviewed. Follow-up and survival data was also collected. Results The median age of the patients was 38 years （26-66years）. 13 patients were premenstrual, and the other one was postmenstrual. 5 patients were FIGO stage Ib1, 3 were Ib2, one was IIa2, 2 were IIb, and 3 were IVb. 10 patients were given radical hysterectomy and/or bilateral salpingo-oophorectomy （BSO） and/or lymphadenectomy, and one FIGO stage IVb patient was given hysterectomy. All the patients received platinum-based chemotherapy. 4 patients with stage Ib1—IIa2 were given adjuvant radiation after radical hysterectomy and 2 patients （stage IIb and IVb） were given radical radiation. With the follow-up time of 3-51months, 7 of 9 patients with stage Ib1—IIa2 alived without disease recurrence, and the other 2 patinets with stage Ib1 and Ib2 developed pulmonary metastasis with disease-free survival （DFS） 10 and 9 moths respectively. One stage IIb patient developed pelvic recurrence at 19 months. The other 4 patients with stage IIb—IVb died of the disease with the overall survival 5—12 months. Conclusion Cervical small cell carcinoma is a kind of highly aggressive neuroendocrine carcinoma and prone to metastasize early. The patients should be treated by multidisciplinary therapy, including surgery, chemotherapy and radiotherapy.