宫颈神经内分泌癌患者预后临床及病理因素分析

Analysis for clinical and pathologic factors of prognosis of patients with neuroendocrine cervicalcarcinoma

目的探讨宫颈神经内分泌癌患者预后生存相关的临床及病理因素。方法选取确诊为宫颈神经内分泌癌(neuroendocrine cervical carcinoma,NECC)患者58例,进行回顾性调查分析研究。采用Kaplan-Meier单因素分析及Cox多因素分析法,分析影响患者预后生存的临床因素及病理因素。结果 58例患者中,65.5%患者属于肿瘤早期(Ⅰ或ⅡA期),年龄中值48岁。78.9%的患者经历手术且73.7%(28/38)的患者接受术后辅助治疗。对于诊断晚期患者,65.0%仅接受化疗,20.0%的患者接受放化疗联合治疗。单因素分析结果表明,晚期、肿瘤≥2 cm及混合瘤是患者预后较差的因素(P<0.05)。多因素分析结果显示,肿瘤分期、肿瘤大小及肿瘤同源性是患者总生存时长的独立预后因素。对于所有患者,39.6%的患者遭遇复发,53.4%(31/58)的患者发生癌转移。而排除诊断为早期的患者中,50.8%的患者遭遇复发。结论肿瘤分期、肿瘤大小及肿瘤同源性是NECC患者独立预后因素。且即使诊断为早期的患者,发生肿瘤转移及复发的频率也较高。

Objective To investigate the clinical and pathologic factors of prognosis of patients with neuroendocrine cervicalcarcinoma（ NECC）. Methods A total of 58 patients who were definitely diagnosed as NECC between 2011 to 2015 were enrolled in the study. The clinical data were retrospectively analysed. One-way analysis of Kaplan Meier and multi-factor Cox regression analysis were used to analyse the clinical and pathologic factors that influenced prognosis and life quality of patients. Results The results showed that 65. 5% of patients were diagnosed at early stage（ stage I to IIA）,with a median age being 48 years,and 78. 9% of patients received surgery therapy and 73. 7%（ 28/38） of patients received postoperative adjuvant treatment. Only 65. 0% of patients who were diagnosed at advanced stage who received chemotherapy and 20. 0% of them received combination treatment of radiotherapy and themotherapy. The univariate analysis results showed that tumor advanced stage,tumor size ≥2 cm and mixed tumor were the main factors that resulted in poor prognosis（ P〈 0. 05）. The multivariate analysis results showed that tumor stage,tumor size and tumor homology were independent prognostic factors of overall survival duration. 39. 3% of patients experienced recurrence,and 53. 4%（ 31/58） of patients had metastasis.50. 8% of patients without early diagnosis experienced recurrence. Conclusion Tumor staging,tumor size and tumor homology are the independent prognostic factors of patients with NECC. Even in the patients who are diagnosed at early stage,the recurrence and distant metastasis are frequently observed.