宫颈小细胞神经内分泌癌19例临床分析

Small Cell Neuroendocrine Carcinoma of the Cervix:Clinical Analysis of 19 Cases

目的:探讨宫颈小细胞神经内分泌癌的临床病理特征、治疗及预后特点。方法:回顾性分析2012年6月—2017年9月郑州大学第一附属医院收治的19例宫颈小细胞神经内分泌癌患者的临床病例资料。结果:患者年龄30～63岁,平均(45.8±10.0)岁。肿瘤最大径2～10 cm,平均(4.29±2.43)cm。ⅠB1期7例,ⅠB2期5例,ⅡA1期2例,ⅡB期4例,ⅢB期1例。其中16例合并人乳头瘤病毒18(HPV18)感染,1例合并HPV16感染。17例行根治性手术+术后辅助化疗,其中8例接受新辅助化疗,9例术后接受放疗,余2例未手术者接受放化疗。1年、2年及5年无进展生存率分别为58.6%、50.2%、12.6%,1年、2年及5年生存率分别为72.8%、54.6%、27.3%。单因素分析发现临床分期(>ⅡA)、合并淋巴结转移、肿瘤大小(>4 cm)为患者预后的危险因素。结论:宫颈小细胞神经内分泌癌发病率低,恶性程度高,确诊依赖于病理,根治性手术是早期患者的主要治疗方案,辅助化疗具有重要意义。

Objective：To discuss the clinical and pathological features, treatment and prognosis of small cell neuroendocrine carcinoma of the cervix（SCNECC）. Methods：From June 2012 to September 2017, 19 cases of SCNECC patients were reviewed and their data were analyzed retrospectively. Results：Patients′ age ranged from 30-63 years, with average of（45.8±10.0） years. Clinical stage： 7 stageⅠB1, 5 stageⅠB2, 2 stageⅡA1, 4 stageⅡB, 1 stageⅢB. The tumor size was 2-10 cm, with the average of（4.29±2.43） cm. 16 cases were positive for HPV 18, and 1 case was positive for HPV16. 17 patients underwent radical surgery followed by adjuvant chemotherapy, including 8 patients were treated by neoadjuvant chemotherapy,9 patients received radiotherapy. Two patients who didn′t received surgery were treated by chemoradiotherapy. The disease-free 1-, 2-, and 5-year survival rates were 58.6%, 50.2%, 12.6% respectively. The overall 1-, 2-, and 5-year survival rates were72.8%, 54.6%, 27.3%, respectively. Univariate analysis showed that clinical stage（ⅡA）, lymph node metastasis and the tumor size（4 cm） were the prognostic risk factors. Conclusions：Small cell neuroendocrine carcinoma of the cervix is a rare disease and associated with high mortality. The diagnosis relys on pathology. Radical surgery is the major therapy for early-stage patients, adjuvant chemotherapy has important significance.