国际妇产科学杂志

国际妇产科学杂志 ›› 2021, Vol. 48 ›› Issue (4): 467-471.doi: 10.12280/gjfckx.20200636

• 妇科肿瘤研究 论著 • 上一篇    下一篇

宫颈小细胞神经内分泌癌的临床特点及治疗分析

潘忠勉, 石凤娟, 李力()   

  1. 530021 南宁,广西医科大学附属肿瘤医院妇瘤科暨区域性高发肿瘤早期防治研究教育部重点室验室
  • 收稿日期:2020-07-16 出版日期:2021-08-15 发布日期:2021-09-01
  • 通讯作者: 李力 E-mail:lili@gxmu.edu.cn
  • 基金资助:
    广西科学研究与技术开发计划课题(桂科攻14124004)

Clinical Features and Treatment Analysis of Small Cell Neuroendocrine Carcinoma of the Cervix

PAN Zhong-mian, SHI Feng-juan, LI Li()   

  1. Department of Gynecologic Oncology, Guangxi Medical University Affiliated Tumor Hospital, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, China
  • Received:2020-07-16 Published:2021-08-15 Online:2021-09-01
  • Contact: LI Li E-mail:lili@gxmu.edu.cn

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摘要：

目的: 回顾性分析宫颈小细胞神经内分泌癌的临床资料,以期为该病的诊断、治疗提供依据。方法: 收集广西医科大学附属肿瘤医院收治的59例宫颈小细胞神经内分泌癌患者的临床资料,并随访患者的预后情况。分别对患者的发病年龄、临床表现、人乳头瘤病毒（HPV）分型检测、病理诊断、不同临床分期的术后病理情况、治疗方案及生存情况进行统计分析。结果: 59例患者的中位发病年龄为43.6岁。临床表现以不规则阴道出血为主（53例,89.8%）。HPV分型检测中HPV18阳性率最高（48例,81.4%）。免疫组织化学检测中,Syn阳性58例（98.3%）,CgA阳性49例（83.1%）,NSE阳性58例（98.3%）,CD56阳性50例（84.7%）。39例临床分期为ⅠB期和ⅡA期的患者接受了手术治疗,其中深肌层浸润者23例（59.0%）,淋巴脉管间隙浸润（LVSI）阳性者11例（28.2%）,盆腔淋巴结转移者9例（23.1%）。随访截止日期为2019年7月31日,所有患者均随访了5年以上,59例患者中有19例存活,40例死亡。平均生存时间为22.6个月,中位生存时间为20.2个月。采用Kaplan-Meier法Log-Rank检验进行生存分析,临床分期（Log-Rank P=0.000）、淋巴结转移（Log-Rank P=0.015）、肿瘤浸润深度（Log-Rank P=0.009）是影响患者预后的因素,而LVSI（Log-Rank P=0.450）、新辅助化疗（Log-Rank P=0.856）、术后辅助放疗（Log-Rank P=0.900）、采用TP/TC（紫杉醇或多西他赛+铂类）方案或EP（依托泊苷+顺铂）方案（Log-Rank P=0.939）对预后的影响不显著。结论: 该病临床表现以不规则阴道出血为主,与HPV18型感染密切相关。早期病例出现浸润及转移,需要免疫组织化学确诊,临床分期越晚、伴淋巴结转移、肿瘤浸润深层预后相对不好,早期诊断和治疗是提高疗效的关键。

关键词: 宫颈肿瘤, 宫颈小细胞神经内分泌癌, 抗肿瘤联合化疗方案, 诊断, 治疗

Abstract:

Objective: The clinical data of small cell neuroendocrine carcinoma of the cervix were analyzed retrospectively in order to provide the basis for the diagnosis and treatment of this disease. Methods: The clinical data of 59 patients with small cell neuroendocrine carcinoma of the cervix were collected in Guangxi Medical University Affiliated Tumor Hospital, and the prognosis of the patients was followed up. The age of onset, clinical manifestations, human papillomavirus (HPV) typing, pathological diagnosis, postoperative pathology in different clinical stages, treatment plan and survival were statistically analyzed. Results: The median age of onset of the 59 patients was 43.6 years. The main clinical manifestation is irregular vaginal bleeding (53 cases, 89.8%). The positive rate of HPV18 in HPV typing was the highest (48 cases, 81.4%). Immunohistochemical tests showed that 58 cases (98.3%) were positive for Syn, 49 cases (83.1%) were positive for CgA, 58 cases (98.3%) were positive for NSE, and 50 cases (84.7%) were positive for CD56. Thirty-nine patients with clinical stage ⅠB and ⅡA underwent surgical treatment, including 23 patients (59.0%) with deep muscular infiltration, 11 patients (28.2%) with lymph vascular space infiltration (LVSI), and 9 patients (23.1%) with pelvic lymph node metastasis. The cut-off date for follow-up was July 31, 2019. All patients were followed for more than 5 years. Of the 59 patients, 19 survived and 40 died. The mean survival time was 22.6 months, and the median survival time was 20.2 months. Kaplan-Meier Log-Rank test was used for survival analysis. Clinical stage (Log-Rank P=0.000), lymph node metastasis (Log-Rank P=0.015), and depth of tumor invasion (Log-Rank P=0.009) were the prognostic factors. LVSI (Log-Rank P=0.450), neoadjuvant chemotherapy (Log-Rank P=0.856), postoperative adjuvant radiotherapy (Log-Rank P=0.900), TP/TC (paclitaxel or docetaxel + platinum) regimen or EP (etoposide+ cisplatin) regimen (Log-Rank P=0.939) had no significant effect on prognosis. Conclusions: The main clinical manifestation of this disease is irregular vaginal bleeding. The disease is closely related to HPV18 infection. Infiltration and metastasis occurred in early cases. Diagnosis of the disease requires immunohistochemistry. The later the clinical stage, with lymph node metastasis and deep tumor infiltration, the worse the prognosis. Early diagnosis and treatment are the key to improve the curative effect.

Key words: Uterine cervical neoplasms, Small cell neuroendocrine carcinoma of the cervix, Antineoplastic combined chemotherapy protocols, Diagnosis, Therapy