宫颈小细胞神经内分泌癌108例临床分析

Clinical analysis of 108 cases of small cell neuroendocrine carcinoma of uterine cervix

目的 探讨宫颈小细胞神经内分泌癌(SCNECC)患者的临床病理特征、治疗及预后影响因素。方法 回顾性分析2011年4月—2018年8月我院收治的108例SCNECC患者的临床资料、生存及复发情况,探讨其预后影响因素。结果 随访截止时间为2021年6月30日,中位随访时间30个月(1~123个月),随访期内死亡65例。SCNECC患者3年和5年累积总生存率分别为46.5%和31.2%,中位总生存时间(OS)为33个月。随访期内71例患者出现复发或转移,3年和5年累积无进展生存率分别为35.3%和30.9%,中位无进展生存时间(PFS)为14个月。单因素分析结果显示,SCNECC患者的预后与分期、根治性手术/放疗+系统性化疗以及≥4个疗程的化疗明显相关(P<0.05),而与年龄、肿瘤大小、肿瘤成分及化疗方案无明显相关性(P>0.05)。其中,分期越早的患者预后越好;实行根治性手术/放疗+联合化疗患者的预后明显好于姑息性放疗或化疗者;化疗疗程≥4的患者预后明显较好,且当化疗疗程提高到6个疗程时,预后可进一步改善。紫杉醇+顺铂/卡铂化疗组与顺铂+依托泊苷化疗组患者的预后无明显差别(P>0.05)。结论 SCNECC患者预后较差,分期越早,则预后越好;早期SCNECC主要行手术+系统性化疗,晚期SCNECC以同步放化疗+系统性化疗为主;给予≥4个疗程的化疗对于患者的预后较有意义,若患者可耐受,建议给予6个疗程化疗;可考虑以紫杉醇+顺铂/卡铂方案替代顺铂+依托泊苷方案化疗。

Objective To investigate the clinicopathologic characteristics,therapy and prognosis of small cell neuroendocrine carcinoma of uterine cervix(SCNECC).Methods A total of 108 cases of SCNECC treated at Hunan Cancer Hospital between Apr.2011 and Aug.2018 were included in this study.Medical charts and clinical data were retrieved and retrospectively reviewed.The Kaplan-Meier method was used for survival analysis.The survival and relapse data after treatment was analyzed retrospectively to explore the prognositic factors.Results The follow-up was until Jun.30,2021.The median follow-up time was 30 months(1~123 months).Sixty-five patients died during the follow-up period.The cumulative overall survival(OS) of 3 and 5 years were respectively 46.5% and 31.2%,with the median OS of 33 months.During the followup,71 cases had recurrence or metastasis.The cumulative progression-free survival(PFS) of 3 and 5 years were respectively 35.3% and 30.9%,and the median PFS was 14 months.The univariate analysis showed that the tumor stage,radical operation/radiotherapy + systemic chemotherapy,and 4 or more courses of systemic chemotherapy were significant prognostic factors(P0.05).The earlier the tumor stage,the better the prognosis.In addition,the patients with radical operation/radiotherapy + combination chemotherapy had better prognosis than those with palliative chemotherapy or radiotherapy.Patients with 4 or more courses of chemotherapy had better prognosis than those without.Especially when the courses of chemotherapy were increased to 6,the PFS and OS of 3 years were further improved.However,there was no difference in prognosis between patients with paciltaxel + cisplatin/carboplatin chemotherapy and those with etoposide + cisplatin chemotherapy(P>0.05).Conclusion SCNECC patients often have poor prognosis.Patients in earlier tumor stage will have better prognosis.Patients in the early stage are mainly treated by radical operation + systemic chemotherapy,while those in the late stage are mainly treated by concurrent chemoradiotherapy + systemic chemotherapy.It is very significant for patients to accept ≥ 4 courses of chemotherapy,even 6 courses if tolerable,to achieve a better prognosis.Paciltaxel + cisplatin/carboplatin could be replaced by the regimen of etoposide + cisplatin.