52例Ⅰ~Ⅱ期宫颈小细胞神经内分泌癌患者临床病理特征及预后因素分析  

Analysis of clinicopathologic factors and prognosis of 52cases of stageⅠ-Ⅱ small cell neuroendocrine carcinoma of the cervix

作　　者：刘晨晨 单天娇 郭慧[1,2] 谢文利 胡永煜 盛修贵 LIU Chen-chen;SHAN Tian-jiao;GUO Hui;XIE Wen-li;HU Yong-yu;SHENG Xiu-gui(School of Medicine and Life Sciences,University of Jinan-Shandong Academy of Medical Sciences,Jinan250022,P.R.China;Department of Gynecologic Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan250117,P.R.China;Department of Gynecologic Oncology,Cancer Hospital of Chinese Academy of Medical Sciences,Shenzhen Center,Shenzhen518116,P.R.China)

机构地区：[1]济南大学·山东省医学科学院医学与生命科学学院,山东济南250022 [2]山东省肿瘤防治研究院(山东省肿瘤医院)妇瘤科,山东第一医科大学(山东省医学科学院),山东济南250117 [3]中国医学科学院北京协和医学院肿瘤医院深圳医院妇瘤科,广东深圳518116

出　　处：《中华肿瘤防治杂志》2020年第16期1320-1326,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：泰山学者(ts201511073)。

摘　　要：目的宫颈小细胞神经内分泌癌(small cell neuroendocrine carcinoma of the cervix,SCNECC)恶性程度高、侵袭能力强、预后差,尚无标准诊疗方案。本研究旨在探讨国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期Ⅰ~Ⅱ期SCNECC的临床病理特征及预后影响因素,为临床诊治提供依据和新思路。方法回顾性分析山东省肿瘤医院2009-01-01-2018-12-30收治的52例FIGOⅠ~Ⅱ期SCNECC患者的临床病理及随访资料,生存分析采用Kaplan-Meier法,预后影响因素的单因素分析选用Log-rank法检验,多因素分析采用Cox回归模型。结果52例患者的中位确诊年龄43岁(26~69岁),免疫组化法检测阳性表达率分别为神经元特异烯醇化酶(neuronspecific enolase,NSE)91.4%(32/35),神经细胞黏附分子(Neural cell adhesion molecule,NCAM/CD56)94.2%(49/52),突触素(synaptophysin,Syn)88.5%(46/52),嗜铬粒蛋白A(chromogranin A,CgA)84.6%(44/52),甲状腺转录因子1(thyroid transcription factor 1,TTF-1)76.2%(16/21)。中位随访时间32.5个月(7.0~96.0个月),死亡23例,3和5年累积总生存率分别为57.9%和40.9%,中位总生存期(overall survival,OS)为48.0个月(17.6~78.4个月)。复发33例,3和5年累积无复发生存率分别为42.8%和34.8%,中位无复发生存期(relapse-free survival,RFS)为27.0个月(12.7~41.3个月)。单因素分析表明,TP方案(紫杉醇类+铂类)和EP(依托泊苷+铂类)方案可明显改善SCNECC患者的RFS和OS(P<0.05),而两者治疗效果差异无统计学意义,P>0.05。多因素分析表明,FIGO分期(HR=2.867,95%CI:1.353~6.307,P=0.009)、宫旁浸润(HR=4.104,95%CI:1.539~10.941,P=0.005)、淋巴结转移(HR=2.585,95%CI:1.076~6.212,P=0.034)、CgA阳性(HR=3.045,95%CI:1.327~6.990,P=0.009)是SCNECC患者RFS独立预后的危险因素。FIGO分期期别晚(HR=2.552,95%CI:1.097~5.934,P=0.030)和淋巴结转移(HR=2.968,95%CI:1.208~7.291,P=0.018)是SCNECC患者OS独立预后的危险因素。结论SCNECC易复发、转移,预后较差,FIGO分�OBJECTIVE Of the various histological types of the cervical cancer,small cell neuroendocrine carcinoma of the cervix(SCNECC)is considered as an aggressive histological type.In general,it has a aggressive behavior and a bad prognosis.The criteria for diagnosis and treatment are not well defined.This study aimed to explore the prognostic impact of clinical and pathological factors on survival among patients with FIGO stageⅠ-ⅡSCNECC.METHODS We retrospectively reviewed a total of 52patients who underwent radical surgery for FIGO stageⅠ-ⅡSCNECC from January 2009to December 2018in Shandong Cancer Hospital.All clinicopathological variables and treatment strategies were reviewed.Kaplan-Meier and Cox regression methods were used for survival analyses.RESULTS In 52patients with FIGO stageⅠ-ⅡSCNECC,the median age were 43years(range 26-69years).NSE,CD56,Syn,CgA and TTF-1were expressed in 91.4%,94.2%,88.5%,84.6%and 76.2%,respectively.During a median follow-up period of 32.5months(range 7.0-96.0months),23patients dead,the 3-year and 5-year overall survival rates were 57.9%and 40.9%,respectively,and the median OS was 48months(range 17.6-78.4months).Totally 43patients experienced disease recurrence,the 3-year and 5-year relapse-free survival rates were 42.8%and 34.8%,respectively,and the median RFS was 27months(range 12.7-41.3months).Univariate analysis showed that TP and EP programs could significantly improve the RFS and OS of SCNECC patients(P<0.05),but there was no significant difference in the treatment effect between them(P>0.05).Multivariate analyses identified FIGO stage(HR=2.867,95%CI:1.353-6.307,P=0.009),parauterine infiltration(HR=4.104,95%CI:1.539-10.941,P=0.005),lymph node metastasis(HR=2.585,95%CI:1.076-6.212,P=0.034),CgA positive(HR=3.045,95%CI:1.327-6.990,P=0.009)were independent prognostic factor for RFS in SCNECC patients.FIGO stage(HR=2.552,95%CI:1.097-5.934,P=0.030),lymph node metastasis(HR=2.968,95%CI:1.208-7.291,P=0.018)were independent prognostic factor for RFS in SCNECC patients.CONCLUSIONS SC

关 键 词：宫颈肿瘤 神经内分泌 预后 治疗 

分 类 号：R737.33[医药卫生—肿瘤]