子宫颈小细胞癌的临床病理特征及治疗

Clinicophathologic characteristics and treatment of small cell carcinoma of uter ine cervix

目的 研究子宫颈小细胞癌 (SCCC)的临床病理特征、预后的影响因素、化疗疗效及其对生存期的影响。方法 分析 12例SCCC患者的临床病理资料。全部标本均行上皮性细胞免疫标记物和与神经内分泌细胞相关的免疫标记物的检测 ,呈阳性反应。临床分期Ⅰb1期 2例 ,Ⅰb2 期 4例 ,Ⅱa期 3例 ,Ⅱb期 1例 ,Ⅲb期 1例 ,Ⅳb期 1例。 9例早期SCCC患者中 ,5例患者术前接受新辅助化疗 ,3例接受术后辅助化疗 ;3例晚期患者接受同步放化疗。结果 早期SCCC患者术后病理证实盆腔淋巴结阳性者占 4 4 .4 % ,淋巴结阳性与阴性的平均无瘤生存期为 16 .1∶2 5 .7个月 ,总生存期为 19∶32个月。 5例接受新辅助化疗者手术成功率为 10 0 % ,其中 1例完全缓解 ,3例肿瘤缩小 >5 0 % ,总有效率为 80 % ,术后病理提示化疗反应者 6 0 % ,平均无瘤生存期为 2 3.4个月 ,总生存期为 2 5 .5个月 ,2年生存率为 80 %。 3例术后辅助化疗者平均无瘤生存期为 17.3个月 ,总生存期为 2 8个月 ,2年生存率为 6 6 .2 %。 3例中晚期患者平均无瘤生存期为 18个月 ,总生存期为 2 7.2个月 ,2年生存率为 6 6 .2 %。结论 同时检测与神经内分泌细胞相关的几种免疫标记 ,可以提高诊断SCCC的准确率。早期SCCC患者死亡率高与淋巴道转移和高危因素的发生率高有关。

Objective To study the clinicophathologic characteristics, prognostic factors, response to chemotherapy, chemotherapy caused disease free interval and overall survival of small cell carcinoma of uterine cervix (SCCUC). Methods Twelve patients with SCCUC were treated from 1995 to 1999, with their clinic ophathologic data retrospectively analyzed. Their stages were Ⅰb 1 2, Ⅰb 2 4 , Ⅱa 3, Ⅱb 1, Ⅲb 1 and Ⅳb1. All 12 samples were assessed through immunohisto chemical methods including epithelial cell markers and neuroendocrine cell marke rs, showing positive results in all. Nine early stage patients underwent radical hyster ectomy with pelvic lymphadenectomy. Five of these 9 patients had recei ved neoadjuvant chemotherapy (NCH) once or twice before operation, three patients received adju vant chemotherapy (ACH) once to six times after operation. Three patients with a dvanced lesions received concurrent chemotherapy twice to four times. Results 44.4%(4/9) of patients treated by pelvic lymphadenectomy showed positive lymph n ode metastasis. The average disease free intervals of patients who showed positi ve or negative pelvic lymph node were 16.1 and 25.7 months, overall survival of 19 and 32 months. The success rate of surgery in the NCH group was 100%, 60% of whom showed chemotherapy response pathologically. They showed overall response r ates of 80% (4/5), 20% CR (1/5) and 60% PR (3/5). Conclusion Poor prognosis of small cell carcinoma of uterine cervix, even the early lesions , is due to its high incidence of pelvic lymph metastasis. The risk factor of th is lesion is hi gh sensitivity to chemotherapy, but chemotherapeutic long term survival should be studied further with more allotted material.