[Clinical analysis of 32 cases with neuroendocrine carcinoma of the uterine cervix in early-stage disease].
[Clinical analysis of 32 cases with neuroendocrine carcinoma of the uterine cervix in early-stage disease].
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早期宫颈神经内分泌癌32例临床分析
DOI：
10.3760/cma.j.issn.0529-567x.2015.03.007
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Man
中科院分区：
文献类型：
--
作者：
Ziyi Wang;Lingying Wu;H. Yao;Yang;Xiao;Bin Li;Rong Zhang;Shao;Man
目的
探讨宫颈神经内分泌癌（NECUC）Ib-IIa期治疗后的生存和复发数据，并分析其预后因素。
方法
方法回顾性分析2005年1月至2013年12月中国医学科学院北京协和医学院附属肿瘤医院收治的32例初发NECUC患者的临床病理资料。中位年龄为37岁（范围：23-57岁）。按国际妇产科联合会（FIGO）临床分期分布：19例Ib 1期，10例Ib 2期，1例IIa 1期，2例IIa 2期。病理类型：小细胞癌22例，不典型类癌1例，混合癌9例。颈部肿瘤直径≥ 4cm者12例，<4cm者20例。所有患者均行广泛子宫切除术和盆腔±腹主动脉旁淋巴结清扫术，其中15例保留一侧或双侧卵巢。病理检查：颈部深基质浸润厚度≥1/2者25例，淋巴管间隙浸润者21例，盆腔和（或）腹主动脉旁淋巴结受累者18例。10例行新辅助化疗（1-3周期），15例行术后化疗（3-6周期）。随访数据于2014年7月更新。中位随访时间为18个月（范围：7-71个月）。回顾性分析NECUC的生存和复发情况，并探讨影响NECUC预后的因素。
结果
13例患者在随访期间死亡。2年和5年的累积无进展生存期（PFS）分别为54.2%和38.1%，估计的中位PFS为29个月。2年和5年的累积总生存率（OS）分别为56.1%和44.9%，估计的中位OS为31个月。复发14例，复发时间3-30个月，中位9个月。复发或转移部位：盆腔2例，肝脏4例，肺3例，肾上腺3例，骨3例，脑2例，胰腺1例，主动脉旁及颈部淋巴结1例，两个或两个以上器官转移3例。复发13例，病死1例，存活1例。单因素分析显示，宫颈病变大小、FIGO分期是影响预后的重要因素（P<0.01），而年龄、肿瘤成分、宫颈间质浸润深度、LVSI、盆腔和（或）腹主动脉旁淋巴结转移、新辅助化疗、辅助放疗和保留卵巢与预后无关（均P>0.05）。
结论
早期NECUC预后差，宫颈病变大小和FIGO分期是影响预后的因素。
OBJECTIVE
To investigate the survival and recurrence data after treatment in neuroendocrine carcinoma of the uterine cervix (NECUC) with stage Ib-IIa, and to analyse its prognostic factors.
METHODS
Thirty-two cases of primary NECUC in early-stage disease treated from Jan. 2005 to Dec. 2013 at Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences were reviewed, and their data of clinicopathologic characteristics were collected and analysed. The median age was 37 years (range, 23-57 years). The distribution by International Federation of Gynecology and Obstetrics (FIGO) clinical stage: 19 cases stage Ib1, 10 cases stage Ib2, 1 case stage IIa1, 2 cases stage IIa2. Pathologic types: 22 cases of small cell carcinoma, 1 case of atypical carcinoid, 9 cases of mixed carcinoma. The diameter of cervical tumor: 12 cases ≥4 cm, 20 cases <4 cm. All patients underwent radical hysterectomy and pelvic ± para-aortic lymphadenectomy, and 15 cases of them were preserved unilateral or bilateral ovaries. Pathologic examination showed that 25 cases with cervical deep stromal invasion thickness ≥1/2, 21 cases with lymph-vascular space invasion (LVSI), and 18 cases with pelvic and (or) para-aortic lymph nodes involvement. Ten cases were performed neoadjuvant chemotherapy (range,1-3 cycles), all patients received postoperative chemotherapy (range,3-6 cycles), and 15 patients were treated with radiotherapy after surgery. The follow-up data were updated on Jul. 2014. The median follow-up time was 18 months (range, 7-71 months). A retrospective analysis was conducted to analyse the survival and recurrence data,and to explore the prognostic factors of NECUC.
RESULTS
Thirteen patients died during the follow-up period. The cumulative progression-free survival (PFS) of 2 and 5 years were respectively 54.2% and 38.1%, and the estimated median PFS was 29 months. The cumulative overall survival (OS) of 2 and 5 years were respectively 56.1% and 44.9%, and the estimated median OS was 31 months. Fourteen cases had recurrence, and the median recurrence time was 9 months (range, 3-30 months). Recurrent or metastatic sites: 2 cases in pelvis, 4 cases in liver, 3 cases in lung, 3 cases in adrenal glands, 3 cases in bones, 2 cases in brain, 1 case in pancreas, 1 case in lymph nodes of para-aorta and neck, and 3 cases had metastasis in two or more organs. Thirteen cases with recurrence died of disease, and another one is alive with disease. The univariate analysis showed that lesion size of the cervix and FIGO stage were significant prognostic factors (P<0.01), while age, tumor components, deep invasion in cervical stromal, LVSI, pelvic and (or) para-aortic lymph nodes involvement, neoadjuvant chemotherapy, adjuvant radiotherapy and preserving ovaries were not significantly associated with prognosis (all P>0.05).
CONCLUSION
The prognosis of NECUC in early-stage is poor and the lesion size of the cervix and FIGO stage are prognostic factors.