Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence
Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence
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DOI：
10.1016/j.ygyno.2003.12.027
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发表时间：
2004-04-01
影响因子：
4.7
通讯作者：
Eifel, PJ
中科院分区：
文献类型：
--
作者：
Viswanathan, AN;Deavers, MT;Eifel, PJ
目标。分析神经内分泌标志物阳性的宫颈小细胞癌患者的复发部位和总生存期。回顾了1980至2000年间在德克萨斯大学安德森癌症中心首次接受宫颈癌治疗的所有女性的记录。51名患者患有I-III期癌症，最初被描述为“小细胞”或“神经内分泌”。45例复查组织学资料，其中21例嗜铬粒细胞、突触素或CD56染色阳性，提示为小细胞神经内分泌癌。局部治疗包括6名患者的根治性子宫切除术和15名患者的放射治疗。13名患者在最初的治疗中接受了化疗。存活患者的中位随访期为83个月(范围25-209个月)。21例患者中有14例(66%)复发。从治疗开始到首次复发的中位时间为8.4个月(3.6-28个月)。大多数患者在死前发生血源性远处转移。在接受放射治疗的15名患者中，只有2人在放射野内复发。然而，5名患者的复发高于腹主动脉旁淋巴结的放射野，2名患者的复发位于阴道内盆腔区域的远端。没有患者将脑转移作为首次复发的唯一部位。然而，两名患者同时出现脑转移和肺转移。5年总存活率为29%；病变范围大于IBI分期或临床证据显示有淋巴结转移的患者无一存活。小细胞神经内分泌型宫颈癌患者预后较差。它们的病程通常以广泛的血源性转移为特征，在照射野之外的局部区域复发也很常见。只有在有肺转移的患者中才能看到脑转移，这表明预防性颅脑照射的益处不大。(C)2004 Elsevier Inc.保留所有权利。
Objective. To analyze the sites of relapse and overall survival in women with neuroendocrine marker-positive small cell carcinoma of the cervix.Methods. The records of all women who had their initial treatment for cervical cancer at The University of Texas M.D. Anderson Cancer Center between 1980 and 2000 were reviewed. Fifty-one patients had stages I-III cancers that were originally described as "small cell" or "neuroendocrine." Histological material was available for reexamination in 45 cases; of these, 21 were found to have small cell neuroendocrine carcinoma (SCNEC) as indicated by positive staining for chromogranin, synaptophysin, or CD56. Local treatment consisted of a radical hysterectomy in six patients and radiation therapy in 15. Thirteen patients received chemotherapy as part of their initial treatment. The median follow-up for surviving patients was 83 months (range, 25-209 months).Results. Fourteen (66%) of the 21 patients had a relapse. The median time to first relapse from the initiation of treatment was 8.4 months (range, 3.6-28 months). Most patients developed hematogenous distant metastases before their death. Only 2 of 15 patients who were treated with radiation therapy had a recurrence within the radiation fields. However, five patients had a recurrence above the radiation fields in the paraaortic lymph nodes, and two patients had a recurrence distal to the pelvic fields in the vagina. No patient had brain metastases as the sole site of first recurrence. However, two patients developed brain metastases concurrently with lung metastases. The overall survival rate was 29% at 5 years; none of the patients who had disease more extensive than stage IBI or clinical evidence of lymph node metastases survived their disease.Conclusions. Patients with small cell neuroendocrine cervical cancer have a poor prognosis. Their course is frequently characterized by the development of widespread hematogenous metastases; locoregional recurrence outside irradiated fields is also frequent. Brain metastases were seen only in patients who also had lung metastases, suggesting that prophylactic cranial irradiation would be of little benefit. (C) 2004 Elsevier Inc. All rights reserved.