子宫颈高级别神经内分泌癌临床病理及预后分析  

Clinicopathological and Prognostic Analysis of High-Grade Neuroendocrine Carcinoma of the Cervix

作　　者：关小米 韩笑笑 刘丽雅[1] 胡庆红[2] 韩丽萍[1] GUAN Xiaomi;HAN Xiaoxiao;LIU Liya(Department of Gynecology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450052,China;Department of Oncology,Women's Hospital School of Medicine Zhejiang University,Hangzhou Zhejiang 310006,China)

机构地区：[1]郑州大学第一附属医院妇科,河南郑州450052 [2]郑州大学第一附属医院放射治疗部,河南郑州450052 [3]浙江大学医学院附属妇产科医院肿瘤科,浙江杭州310006

出　　处：《实用妇产科杂志》2022年第11期857-862,共6页Journal of Practical Obstetrics and Gynecology

基　　金：河南省自然科学基金(编号:212300410394);河南省医学科技攻关计划联合共建项目基金(编号:LHGJ20200367)。

摘　　要：目的:评价子宫颈高级别神经内分泌癌(HGNECC)患者预后相关的临床和病理危险因素,为临床诊治提供参考和新思路。方法:回顾分析郑州大学第一附属医院2010年6月至2021年6月收治的72例HGNECC患者的临床病理及随访资料,通过Kaplan-Meier法及Log-rank检验进行单因素生存分析,采用Cox风险比例模型进行预后相关的多因素分析。结果:(1)临床病理特点:72例HGNECC患者的中位发病年龄为46.5岁(24~71岁),临床表现以不规则阴道流血或接触性出血为主(86.1%,62/72),免疫组化标志物阳性表达率分别为神经细胞黏附分子(NCAM/CD56)81.9%(59/72)、神经元特异烯醇化酶(NSE)87.5%(63/72)、突触素(Syn)79.2%(57/72)、嗜铬粒蛋白A(CgA)52.8%(38/72),Ki-67阳性率为100%,其中Ki-67≥55%者占76.4%(55/72);(2)生存及复发情况:中位无进展生存期(PFS)为35个月(1~102个月),中位总生存期(OS)为42个月(2~116个月),随访期间,死亡38例,复发或转移者27例,3年和5年总生存率分别为63.9%和51.4%;(3)单因素分析显示,国际妇产科联盟(FIGO)2018年分期≥ⅠB3期、淋巴结阳性[盆腔和(或)腹主动脉旁淋巴结转移]、病灶中单纯HGNECC癌成分、宫旁浸润、淋巴脉管间隙浸润(LVSI)、CgA阳性及Ki-67≥55%是影响HGNECC患者预后的危险因素(P<0.05);(4)多因素分析显示,FIGO分期≥ⅠB3期、淋巴结阳性及CgA阳性是影响HGNECC患者PFS的独立危险因素(HR>1,P<0.05),而FIGO分期≥ⅠB3期、淋巴结阳性及Ki-67≥55%是影响HGNECC患者OS的独立危险因素(HR>1,P<0.05)。结论:HGNECC是一种罕见的子宫颈恶性肿瘤,主要临床表现为不规则阴道流血及接触性出血,易发生复发及转移,预后较差。FIGO分期≥ⅠB3期及淋巴结阳性是影响HGNECC患者预后的独立危险因素。CgA及Ki-67是HGNECC患者预后的潜在影响因素,或可成为HGNECC预后评估的有效标志物。Objective:To evaluate the clinical and pathological risk factors related to the prognosis of patients with high-grade neuroendocrine carcinoma of the cervix(HGNECC) and to provide reference and new ideas for clinical diagnosis and treatment.Methods:Clinicopathological and follow-up data of 72 HGNECC patients admitted to the First Affiliated Hospital of Zhengzhou University from June 2010 to June 2021 were retrospectively analyzed.Univariate survival analysis was performed by Kaplan-Meier method and Log-rank test.Cox proportional hazards model was used for multivariate analysis related to prognosis.Results:(1)Clinical and pathological characteristics: In 72 patients with HGNECC,the median onset age was 46.5 years(24~71 years).The main clinical manifestations were irregular vaginal bleeding or contact bleeding(86.1%,62/72).The positive expression rates of immunohistochemical markers were 81.9%(59/72) of NCAM/CD56,87.5%(63/72) of NSE,79.2%(57/72) of Syn, 52.8%(38/72)of Chromogranin A(CgA),and 100% of Ki-67,of which, Ki-67≥55% accounted for 76.4%(55/72).(2)Survival and recurrence: the median progression free survival(PFS)was 35 months(1-102 months).The median total survival(OS) was 42 months(2-116 months).38 patients died during the follow-up period and 27 cases recurred or metastasized.The 3-year and 5-year overall survival rates were 63.9% and 51.4%,respectively.(3)Univariate analysis showed that FIGO staging(2018)≥IB3,positive lymph nodes(pelvic and/or abdominal para-aortic lymph node metastasis),simple HGNECC components in the lesions, parauterine infiltration, lymph-vascular space invasion(LVSI),CgA positive and Ki-67≥55% were the risk factors affecting the prognosis of HGNECC patients(P<0.05).(4)Multivariate analysis identified that FIGO staging≥IB3,positive lymph nodes and positive CgA were independent risk factors for PFS prognosis in patients with HGNECC(HR>1,P<0.05).While FIGO staging≥IB3,positive lymph nodes and Ki-67≥55% were independent risk factors for OS prognosis in patients with HGNECC(HR

关 键 词：子宫颈肿瘤 神经内分泌癌 治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]