宫颈小细胞癌与非小细胞癌临床特征及预后的对比研究

Comparatively Analysis on Clinicopathological Characteristics and Prognosis of Small Cell Carcinoma of the Cervix(SCCC) and Non-SCCC-A Single Center of Clinical Research

目的:对比性研究宫颈小细胞癌(SCCC)与宫颈非小细胞癌在发病特点、临床特征、治疗方案、预后情况等方面的差异,并探究影响其预后的因素。方法:回顾性分析2003年5月至2015年6月四川大学华西第二医院收治的宫颈小细胞癌患者63例(SCCC组)和根据诊断时间及相近的FIGO分期配对的宫颈非小细胞癌(鳞癌、腺癌)患者60例(对照组)的临床病理资料及生存情况,采用Pearson卡方检验或Fisher确切概率法比较两组临床特征、治疗方案等方面的差异,Kaplan-Meier方法比较两组总体生存率及无病生存率的差异,单因素和多因素分析影响SCCC预后的因素。结果:(1)SCCC组患者初诊的中位年龄较对照组年轻(40岁vs 44岁,P=0.001),淋巴结转移率、宫旁浸润率、脉管累及率及手术切缘阳性率也均显著高于对照组(P<0.05)。而在临床症状、肿块大小、诊断分期、术前治疗、术后治疗等方面比较两者差异均无统计学意义(P>0.05)。(2)生存分析中,SCCC组的累积5年生存率(29.2%)与累积5年无瘤生存率(26.6%),显著低于对照组(分别为82.6%、76.7%),差异有统计学意义(P<0.05)。(3)在影响SCCC预后的多因素COX多元回归分析结果显示,有淋巴结转移是影响患者5年总生存率和5年无瘤生存率的独立危险因素(HR=4.784、3.067,P<0.05)。肿块直径≥4 cm是影响5年总生存率的独立危险因素(HR=3.610,P<0.05)和FIGO分期(ⅠB2以上)是影响无瘤生存率的独立危险因素(HR=2.793,P<0.05)。结论:SCCC患者更年轻,其临床症状、病灶外观、治疗方案等和宫颈非小细胞癌相似,但淋巴结转移率、脉管累及率、宫旁浸润率及手术切缘阳性率均显著高于宫颈非小细胞癌,预后极差。影响SCCC患者预后的主要因素为有无淋巴结转移、FIGO分期、肿块直径。

Objective：To investigate the differences between patients with small cell carcinoma of the cervix and other type of cervical cancer on clinicopathological characteristics ,treatment, prognosis through the retrospec- tive analysis,also study the prognostic factors in patients with SCCC. Methods：The patients with SCCC（63 ca- ses,research group） and patients with Non-SCCC（60 cases,control group） such as squamous cell carcinoma and adenocarcinoma of cervix were chosen during May 2003 and June 2015 in department of obstetrics and gy- necology,west China second university hospital. The clinical pathological and survival data were collected, sort out, checked and analyzed. Chi-square test or Fisher＇s exact probability method was used to compare the differ- ences of clinical features between the two groups. The 5-year disease-free survival（DFS） rate and 5-year overall survival（OS） rate were generated using the Kaplan-Meier method. Univariate and multivariate analysis were ap- plied to research the prognostic factors. Results： The median age of the patients in research group was 40years old,younger than control group whose median age was 44 years old（ P =0. 001 ）. The rate of lymph node metastasis,parametrial infiltration,vascular involvement and positive surgical margins in research group were sig- nificantly higher than those of control group （ P 〈 0.05）. There were no significantly differences between two groups in clinical symptoms, FIGO stage,therapeutic schedule. ln the survival analysis,the research group esti- mated 5-year overall survival （OS） rate （29.2%） and estimated 5-year disease-free survival rate （DFS） （26.6%） was significantly lower than those of the control group（82.6% ,and 76.7%, respectively） P 〈 0, 05, In the COX multivariate regression analysis, the results showed that the lymph node metastasis was the independ- ent factor influencing overall survival rate and disease-free survival rate （HR = 4. 784 3. 067, P 〈 0.05）. In addi- tion, the tumor size was the independent factor influencing overall survival rate （ HR = 3. 610, P 〈 0.05 ）, and ad- vanced FIGO staging was the independent factor influencing disease-free survival rate （ HR = 2. 793, P 〈 0. 05 ）. Conclusions：The patients with SCCC were younger than other cervical cancer,and the clinical symptoms,cervi- cal appearaoce,treatment between the two types are almost the same. However,The rate of lymph node metas- tasis, parametrial infiltration ,vascular involvement and positive surgical margins in patients with SCCC were signifi- cantly higher than other cervical cancer, and the prognosis of the patients with SCCC was very poor. The main prognostic factors were lymph node metastasis,advanced FIGO stage and tumor size.