早期子宫颈神经内分泌癌27例临床分析
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摘要
目的分析早期子宫颈神经内分泌癌(NECUC)复发及生存情况,探讨其治疗及预后。方法回顾性分析27例早期NECUC患者的临床病理资料。Kaplan-Meier法和log-rank法进行生存分析。结果 (1) 2年OS、PFS分别为88. 8%、66. 7%; 5年总生存时间(OS)、无进展生存时间(PFS)分别为74. 1%、59. 2%,中位PFS为18个月。随访期内40%患者复发,其中81. 8%为远处转移。(2)术后单纯化疗(CT)者(n=7)与放疗(RT)/同步放化疗(CCRT)+CT者(n=20)的2年、5年OS及PFS差异无统计学意义(P> 0. 05);术后依托泊苷+铂类(EP)≥5个周期(n=16)和Non-EP≥5个周期(n=11)化疗的2年OS、5年OS及PFS差异有统计学意义(P <0. 05)。(3)单因素生存分析和多因素分析显示:淋巴转移,术后Non-EP≥5化疗均是复发的危险因素。结论 (1)早期NECUC预后较差,2年内约40%患者复发,且远处转移较显著。(2)术后EP≥5个周期化疗能提高患者的生存率。额外的RT或CCRT未能明显提高患者的生存率。(3)淋巴转移和术后Non-EP≥5化疗是术后复发的危险因素。
Objective To analyze the recurrence and survival of early stage neuroendocrine carcinoma of the uterine cervix( NECUC),and to investigate the treatment method and the prognostic factors. Methods The clinical and pathological data of 27 patients with early NECUC were retrospectively analyzed. Kaplan-Meier and log-rank methods were used for survival analyses. Results( 1) Over survival time( OS) and PFS were 88. 8% and 66. 7% respectively in 2 years,and 74. 1% and 59. 2% respectively in 5 years. The median PFS was 18 months. During the follow-up period,40% patients had recurrence,and 81. 8% of which had distant metastases.( 2) There was no significant difference in OS and PFS at 2 and 5 years( P > 0. 05) between 7 patients undergoing chemotherapy( CT) after surgery and 20 patients receiving radiotherapy( RT)/combined radiochemotherapy( CCRT) + chemotherapy. And there was significant difference in OS and PFS at 2 and 5 years( P < 0. 05) between 16 patients with chemotherapy of EP ≥ 5 cycles and 11 patients with Non-EP ≥ 5 cycles after surgery.( 3) Single factor survival analysis and the multivariable Cox regression model showed that lymphatic metastasis,postoperative adjuvant chemotherapy of Non-EP ≥ 5 cycles were risk factors for recurrence. Conclusion( 1) Early NECUC has a poor prognosis,with about 40% of patients relapsed within 2 years and significant distant metastasis.( 2) Treatment with EP ≥ 5 cycles of EP regimen can improve patient survival.Additional radiotherapy or concurrent chemoradiotherapy cannot significantly improve patient survival.( 3) Lymphatic metastasis and treatment of Non-EP ≥ 5 cycles after surgery are risk factors for postoperative recurrence.
Objective To analyze the recurrence and survival of early stage neuroendocrine carcinoma of the uterine cervix( NECUC),and to investigate the treatment method and the prognostic factors. Methods The clinical and pathological data of 27 patients with early NECUC were retrospectively analyzed. Kaplan-Meier and log-rank methods were used for survival analyses. Results( 1) Over survival time( OS) and PFS were 88. 8% and 66. 7% respectively in 2 years,and 74. 1% and 59. 2% respectively in 5 years. The median PFS was 18 months. During the follow-up period,40% patients had recurrence,and 81. 8% of which had distant metastases.( 2) There was no significant difference in OS and PFS at 2 and 5 years( P > 0. 05) between 7 patients undergoing chemotherapy( CT) after surgery and 20 patients receiving radiotherapy( RT)/combined radiochemotherapy( CCRT) + chemotherapy. And there was significant difference in OS and PFS at 2 and 5 years( P < 0. 05) between 16 patients with chemotherapy of EP ≥ 5 cycles and 11 patients with Non-EP ≥ 5 cycles after surgery.( 3) Single factor survival analysis and the multivariable Cox regression model showed that lymphatic metastasis,postoperative adjuvant chemotherapy of Non-EP ≥ 5 cycles were risk factors for recurrence. Conclusion( 1) Early NECUC has a poor prognosis,with about 40% of patients relapsed within 2 years and significant distant metastasis.( 2) Treatment with EP ≥ 5 cycles of EP regimen can improve patient survival.Additional radiotherapy or concurrent chemoradiotherapy cannot significantly improve patient survival.( 3) Lymphatic metastasis and treatment of Non-EP ≥ 5 cycles after surgery are risk factors for postoperative recurrence.
引文
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[9] YUAN L,JIANG H,LU Y,et al. Prognostic factors of surgically treated early-stage small cell neuroendocrine carcinoma of the cervix[J]. Int J Gynecol Cancer,2015,25(7):1315-1321.
[10] TAS S,TOP H. Intraorbital wooden foreign body:clinical analysis of 32 cases,a 10-year experience[J]. Ulus Travma Acil Cerrahi Derg,2014,20(1):51-55.
[11] CHANG T C,LAI C H,TSENG C J,et al. Prognostic factors in surgically treated small cell cervical carcinoma followed by adjuvant chemotherapy[J]. Cancer,1998,83(4):712-718.
[12] ABELER V M,HOLM R,NESLAND J M,et al. Small cell carcinoma of the cervix. A clinicopathologic study of 26patients[J]. Cancer,1994,73(3):672-677.
[13] VISWANATHAN A N,DEAVERS M T,JHINGRAN A,et al. Small cell neuroendocrine carcinoma of the cervix:outcome and patterns of recurrence[J]. Gynecol Oncol,2004,93(1):27-33.
[14]王子毅,吴令英,姚洪文,等.早期子宫颈神经内分泌癌32例临床分析[J].中华妇产科杂志,2015,50(3):198-203.
[15] WANG K L,CHANG T C,JUNG S M,et al. Primary treatment and prognostic factors of small cell neuroendocrine carcinoma of the uterine cervix:a Taiwanese Gynecologic Oncology Group study[J]. Eur J Cancer,2012,48(10):1484-1494.
[2] SATOH T,TAKEI Y,TREILLEUX I,et al. Gynecologic Cancer Inter Group(GCIG)consensus review for small cell carcinoma of the cervix[J]. Int J Gynecol Cancer,2014,24(9 Suppl 3):102-108.
[3] COHEN J G,KAPP D S,SHIN J Y,et al. Small cell carcinoma of the cervix:treatment and survival outcomes of 188 patients[J]. Am J Obstet Gynecol,2010,203(4):347.
[4] SIEGEL R L,MILLER K D,JEMAL A. Cancer Statistics,2017[J]. CA Cancer J Clin,2017,67(1):7-30.
[5] LEE J M,LEE K B,NAM J H,et al. Prognostic factors in FIGO stage IB-IIA small cell neuroendocrine carcinoma of the uterine cervix treated surgically:results of a multicenter retrospective Korean study[J]. Ann Oncol,2008,19(2):321-326.
[6] NAGAO S,MIWA M,MAEDA N,et al. Clinical features of neuroendocrine carcinoma of the uterine cervix:a single-institution retrospective review[J]. Int J Gynecol Cancer,2015,25(7):1300-1305.
[7] HUANG L,LIAO L M,LIU A W,et al. Analysis of the impact of platinum-based combination chemotherapy in small cell cervical carcinoma:a multicenter retrospective study in Chinese patients[J]. BMC Cancer,2014,14(1):140.
[8] INTARAPHET S,KASATPIBAL N,SIRIAUNKGUL S,et al. Prognostic factors for small cell neuroendocrine carcinoma of the uterine cervix:an institutional experience[J]. Int J Gynecol Cancer,2014,24(2):272-279.
[9] YUAN L,JIANG H,LU Y,et al. Prognostic factors of surgically treated early-stage small cell neuroendocrine carcinoma of the cervix[J]. Int J Gynecol Cancer,2015,25(7):1315-1321.
[10] TAS S,TOP H. Intraorbital wooden foreign body:clinical analysis of 32 cases,a 10-year experience[J]. Ulus Travma Acil Cerrahi Derg,2014,20(1):51-55.
[11] CHANG T C,LAI C H,TSENG C J,et al. Prognostic factors in surgically treated small cell cervical carcinoma followed by adjuvant chemotherapy[J]. Cancer,1998,83(4):712-718.
[12] ABELER V M,HOLM R,NESLAND J M,et al. Small cell carcinoma of the cervix. A clinicopathologic study of 26patients[J]. Cancer,1994,73(3):672-677.
[13] VISWANATHAN A N,DEAVERS M T,JHINGRAN A,et al. Small cell neuroendocrine carcinoma of the cervix:outcome and patterns of recurrence[J]. Gynecol Oncol,2004,93(1):27-33.
[14]王子毅,吴令英,姚洪文,等.早期子宫颈神经内分泌癌32例临床分析[J].中华妇产科杂志,2015,50(3):198-203.
[15] WANG K L,CHANG T C,JUNG S M,et al. Primary treatment and prognostic factors of small cell neuroendocrine carcinoma of the uterine cervix:a Taiwanese Gynecologic Oncology Group study[J]. Eur J Cancer,2012,48(10):1484-1494.