Cycles of cisplatin and etoposide affect treatment outcomes in patients with FIGO stage I-II small cell neuroendocrine carcinoma of the cervix
Cycles of cisplatin and etoposide affect treatment outcomes in patients with FIGO stage I-II small cell neuroendocrine carcinoma of the cervix
复制标题
顺铂和依托泊苷的周期影响FIGO I-II期宫颈小细胞神经内分泌癌患者的治疗结果。
DOI：
10.1016/j.ygyno.2017.09.022
复制
发表时间：
2017-12-01
影响因子：
4.7
通讯作者：
Yang, Huijuan
中科院分区：
文献类型：
--
作者：
Pei, Xuan;Xiang, Libing;Yang, Huijuan
目标。本研究旨在探讨宫颈小细胞神经内分泌癌(SCNEC)根治术后患者的预后和预后因素，以及辅助治疗对FIGO I-II期宫颈小细胞神经内分泌癌患者生存率的影响。对92例接受SCNEC根治术的患者进行单机构回顾分析。对所有的临床病理变量和治疗策略进行综述。采用Kaplan-Meier和Cox回归方法进行生存分析。中位随访期38个月(23.6-52.4)，43例(46.7%)患者复发，35例(81.4%)有远处转移。全组3年无复发生存率(RFS)为50.1%。中位RFS为39个月。多因素分析证实，淋巴结转移、宫旁侵犯和依托泊苷联合铂(EP)化疗周期是影响复发的独立预后因素。与其他疗法(n=46)相比，至少5个周期的EP(EP 5+，n=39)辅助化疗可改善5年生存率(67.6%vs.20.9%，p<；0.001)。附加放疗或同步放化疗未能证实EP 5+患者的RFS进一步改善，这一发现在具有高危因素(淋巴结阳性或子宫旁阳性)的患者中是一致的。一半的I-II期SCNEC患者在3年内经历了疾病失败，远处转移是一个突出的问题。EP方案至少5个周期可改善根治性手术后的远期RFS。即使在有高危因素的患者中，额外的辐射也可能是不必要的。(C)2017 Elsevier Inc.保留所有权利。
Objective. This study sought to explore the outcomes and prognostic factors of patients with small cell neuroendocrine carcinoma of the cervix (SCNEC) and to determine the effects of adjuvant treatment on survival in patients with FIGO stage I-II SCNEC after radical surgery.Methods. A single-institution retrospective analysis was performed in 92 patients who underwent radical surgery for SCNEC. All clinicopathological variables and treatment strategies were reviewed. Kaplan-Meier and Cox regression methods were used for survival analyses.Results. During a median follow-up period of 38 months (23.6-52.4), 43 (46.7%) patients experienced disease recurrence, and distant metastases were documented in 35 (81.4%) patients. The 3-year recurrence-free survival (RFS) for the entire group was 50.1%. The median RFS was 39 months. The multivariate analysis confirmed that lymph node metastasis, positive parametrial extension and cycles of etoposide plus platinum (EP) were independent prognostic factors for disease recurrence. Adjuvant chemotherapy for at least 5 cycles of EP (EP 5 +, n = 39) was associated with improved 5-year RFS compared with other treatments (n = 46) (67.6% vs. 20.9%, p < 0.001). Additional radiotherapy or concurrent chemoradiation failed to validate further improved RFS in patients with EP 5 +, and this finding was consistent in the subset of patients with high-risk factors (positive lymph nodes or positive parametrium).Conclusions. Half of stage I-II SCNEC patients experienced disease failure within 3 years, and distant metastasis was an outstanding issue. EP regimen for at least 5 cycles improved long-term RFS after radical surgery. Additional radiation might be unnecessary, even in patients with high-risk factors. (C) 2017 Elsevier Inc. All rights reserved.