宫颈小细胞癌临床病理研究

Clinicopathological features of cervical small cell carcinoma

目的探讨宫颈小细胞癌的临床病理特征、诊断、治疗与预后的影响因素。方法收集26例宫颈小细胞癌的资料,回顾性分析其临床病理学特点、诊断要点及预后。结果 26例患者中位发病年龄36.5岁,均确诊为小细胞癌,免疫组化染色阳性抗体主要为Syn(23/23)、Cg A(14/22)、CD56(16/18)。所有患者均行化疗,其中22例行根治性子宫切除术+术后放化疗。患者3年总体生存率和无病生存率分别为64.3%和60%。FIGOⅠb-Ⅱa期与Ⅱb-Ⅳ期患者3年总体生存率分别为81.8%和25%,差异显著(P<0.05);肿瘤直径≤4 cm者比肿瘤大者3年生存率更高(P<0.05);Cg A阳性者比阴性者更易发生复发或转移(P<0.05)。结论宫颈小细胞癌确诊依靠组织形态学特点和免疫组化结果;目前多采用手术、化疗和放疗综合治疗;FIGO分期、肿瘤大小及Cg A染色情况与预后相关。

Objective To investigate the clinicopathological characteristics,diagnosis,treatment and prognosis of cervical small cell carcinoma（ SCCC）. Methods Total 26 SCCC cases were collected. Clinical and pathological features,treatment and prognosis were retrospectively evaluated in patients. Results Among the 26 pathological confirmed cases,the median age of SCCC was 36. 5 years. Immunohistochemical assay showed that the primarily positive expression of antibodies were Syn（ 23 /23）,Cg A（ 14 /22） and CD56（ 16 /18）. All of the patients were received chemotherapy,and 22 of them were given radical hysterectomy and postoperative chemotherapy / radiation. The 3-year overall survival（ OS） and 3-year disease-free survival（ DFS） of patients were 64. 3% and 60%,respectively. The overall3-year survival for patients with Ⅰb-Ⅱa and Ⅱb-Ⅳ was 81. 8% and 25%,respectively（ P〈0. 05）. Patients with tumors≤4 cm had longer 3-year overall survival than that of patients with 〉4 cm lesions（ P〈0. 05）. Cg A positive staining carried a significantly worse prognosis in patients（ P〈0. 05）. Conclusion SCCC is diagnosed by histological detection and IHC stain. Combined therapy including preoperative chemotherapy / radiation, surgical treatment and postoperative chemotherapy / radiation are suggested for the disease. FIGO stage,tumor mass size and Cg A staining may act as surrogate factors for prognosis.