化疗联合术后放疗对宫颈小细胞神经内分泌癌生存的影响——基于SEER数据库的回顾性研究

Effect of chemotherapy combined with postoperative adjuvant radiotherapy on the survival of small cell neuroendocrine carcinoma of the cervix:a retrospective study based on SEER database

目的探讨化疗联合术后辅助放疗对早期和中晚期(Ⅰ~ⅡA和ⅡB~Ⅳ)宫颈小细胞神经内分泌癌(SCNEC)患者生存的影响及其预后因素分析。方法首先利用SEER数据库搜索并筛选出2004—2016年接受化疗的SCNEC患者269例,然后根据治疗方案分为4组:化疗+术后放疗组、化疗+手术组、化疗+放疗组及单纯化疗组,采用Kaplan-Meier曲线分别比较Ⅰ~ⅡA期和ⅡB~Ⅳ期患者在4种治疗方案下的总生存(OS)情况,采用Log-rank检验及Cox回归分析评估不同临床病理因素对预后的影响。结果对于Ⅰ~ⅡA期患者,化疗+术后放疗组、化疗+手术组、化疗+放疗组及单纯化疗组的5年OS率分别为39.9%、71.7%、24.5%和0,与化疗+术后放疗组相比,化疗+手术组的预后更好(HR 0.403,95%CI:0.112~1.112,P=0.047)。对于ⅡB~Ⅳ期患者,化疗+术后放疗组、化疗+手术组、化疗+放疗组及单纯化疗组的5年OS率分别为35.2%、24.3%、17.7%和0,其中化疗+手术组、化疗+放疗组及单纯化疗组(HR 1.726,95%CI:0.944~3.157;HR 1.605,95%CI:0.968~2.661;HR 5.632,95%CI:3.143~10.093,P<0.05)的预后差于化疗+术后放疗组。另外,与年龄≤60岁、肿瘤直径<4 cm的情况相比,年龄>60岁(HR 7.868,95%CI:3.032~20.415;HR 1.465,95%CI:1.006~2.435,P<0.05)、肿瘤直径≥4 cm(HR 2.576,95%CI:1.056~6.287;HR 1.965,95%CI:1.026~3.766,P<0.05)的Ⅰ~ⅡA期和ⅡB~Ⅳ期患者的预后均较差。结论化疗联合术后辅助放疗未能改善早期(Ⅰ~ⅡA)SCNEC患者的OS,但可显著改善中晚期(ⅡB~Ⅳ)患者的OS,年龄、肿瘤大小和治疗方案是影响其预后的独立危险因素。

Objective To investigate the effect of chemotherapy combined with postoperative adjuvant radiotherapy on the overall survival(OS)of early and advanced(Ⅰ-ⅡA andⅡB-Ⅳ)small cell neuroendocrine carcinoma of the cervix(SCNEC)patients and analyze the prognostic factors.Methods The Surveillance,Epidemiology and End Result(SEER)database was used to search and screen out 269 SCNEC patients who received chemotherapy from 2004 to 2016.These patients were divided into four groups according to different treatment regimens:chemotherapy+postoperative radiotherapy group,chemotherapy+surgery group,chemotherapy+radiotherapy group and chemotherapy-alone group.Kaplan-Meier curve was utilized to compare the OS of SCNEC patients with stageⅠ-ⅡA andⅡB-Ⅳwith different treatment regimens.Log-rank test and Cox regression analysis were used to evaluate significant clinicopathological factors on prognosis.Results For patients with stageⅠ-ⅡA,the 5-year OS rate of chemotherapy+postoperative radiotherapy group,chemotherapy+surgery group,chemotherapy+radiotherapy group and chemotherapy-alone group were 39.9%,71.7%,24.5%and 0,respectively.Among patients with stageⅠ-ⅡA,chemotherapy+surgery group had a better prognosis(HR 0.403,95%CI:0.112-1.112,P=0.047)than chemotherapy+postoperative radiotherapy group.For stageⅡB-Ⅳpatients,the 5-year OS rate of the chemotherapy+postoperative radiotherapy group,chemotherapy+surgery group,chemotherapy+radiotherapy group and chemotherapy-alone group were 35.2%,24.3%,17.7%and 0,respectively.Among patients with stageⅡB-Ⅳ,chemotherapy+surgery group,chemotherapy+radiotherapy group and chemotherapy-alone group all had worse prognosis(HR 1.726,95%CI:0.944-3.157;HR 1.605,95%CI:0.968-2.661;HR 5.632,95%CI:3.143-10.093,P<0.05)than chemotherapy+postoperative radiotherapy group,respectively.In addition,the patients whose age≤60 years old and tumor diameter<4 cm had a worse prognosis compared to those older than 60 years old(HR 7.868,95%CI:3.032-20.415;HR 1.465,95%CI:1.006-2.435,P<0.05)and tumor diameter≥4 cm(HR 2.576,95%CI:1.056-6.287;HR 1.965,95%CI:1.026-3.766,P<0.05).Conclusions Chemotherapy combined with postoperative adjuvant radiotherapy can′t improve the OS of patients with early(Ⅰ-ⅡA)SCNEC,but can significantly improve the OS of advanced(ⅡB-Ⅳ)patients.Age,tumor size and treatment regimens are independent risk factors.