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投稿时间：2021-07-05 网络发布日期：2022-03-20
投稿时间：2021-07-05 网络发布日期：2022-03-20
中文摘要: 目的 探讨宫颈小细胞神经内分泌癌（SCNEC）的临床病理特征、治疗及预后影响因素。 方法 回顾性分析空军军医大学第一附属医院妇科2009年12月至2019年5月收治的24例SCNEC患者的临床病例资料，采用Kaplan-Meier法和Log-rank检验分析不同病理特征患者的生存预后。 结果 24例患者均为初治病例，其中合并妊娠者2例。23例患者接受了根治性手术治疗，4例ⅡB期患者术前均行新辅助化疗；ⅡB期以下的患者中14例术后补充放化疗,其中有11例为同步放化疗；5例术后仅补充化疗；1例术后选择免疫治疗。24例中单纯SCNEC者为13例，混合型11例。随访时间7～100个月，有11例复发，其中1例带瘤生存，其余10例死亡。最常见复发部位为肺脏（54.55%），其次为肝脏（27.27%），2年累积无进展生存率为54.17%，总生存率为58.33%，选择免疫治疗的患者预后较好。病理类型单一、临床分期≥ⅡA2期、开腹手术及病灶直径≥2 cm可能是影响宫颈SCNEC预后的危险因素（P＜0.05,P＜0.01），同步放化疗有助于改善预后（P＜0.05,P＜0.01）。 结论 宫颈SCNEC发病率低，恶性程度高，预后差，根治性手术及放化疗是目前主要的治疗方案，免疫治疗是探索的新方向。妊娠合并SCNEC进展更快，预后更差，需多学科合作制定个体化治疗方案。
Abstract:Objective To investigate the clinicopathological features, therapy and prognostic factors of small cell neuroendocrine carcinoma (SCNEC) of the cervix. Methods The clinical data of 24 cases of SCNEC treated in the First Affiliated Hospital of Air Force Military Medical University from December 2009 to May 2019 were retrospectively analyzed. Kaplan-Meier method and Log-rank test were used to analyze the survival and prognosis of SCNEC patients with different pathological characteristics. Results Among 24 newly diagnosed patients with SCNEC of the cervix, there were 2 patients with pregnancy,23 patients received radical surgery and 4 patients with stage ⅡB received neoadjuvant chemotherapy before operation. Out of 14 patients with SCNEC below stage ⅡB received postoperative adjuvant radiotherapy and chemotherapy, 11 cases received concurrent radiotherapy and chemotherapy,5 cases received supplementary chemotherapy and 1 case received postoperative immunotherapy. There were 13 cases of single SCENC and 11 cases of mixed-type SCENC. During the follow-up period ranged from 7 to 100 months, there were 11 cases of recurrence, in whom 1 case survived with tumor, and 10 cases died. The most common site of recurrence was the lung（54.55%）, followed by the liver（27.27%）.The 2-year cumulative progression-free survival rate and the overall survival rate were 54.17% and 58.33%, respectively. The patient treated with immunotherapy had a good prognosis. Single pathological type, clinical pathological stage (greater than or equal to ⅡA2), laparotomy and tumor diameter ≥2 cm were the independent risk factors influencing prognosis of SCNEC（P＜0.05, P＜0.01）. Simultaneous radiotherapy and chemotherapy was helpful to improve the prognosis（P＜0.05,P＜0.01）. Conclusion SCNEC of the cervix is highly malignant and has poor prognosis. The mainstay treatments for SCNEC are radical surgery, radiotherapy and chemotherapy, with immunotherapy as a new direction in the treatment. SCNEC progresses faster, with worse prognosis in the pregnant women complicated with it. So, the multidisciplinary cooperation is needed to formulate an individualized treatment plan for the pregnant women complicated with SCNEC.
文章编号： 中图分类号：R737.33 文献标志码：A
基金项目:国家自然科学基金（81972427）；陕西省重点研发计划项目(2020ZDLSF02-02)
| 作者 | 单位 |
| 李玲霞1 | 1. 空军军医大学第一附属医院妇产科，陕西 西安 710032 |
| 刘淑娟1 | 1. 空军军医大学第一附属医院妇产科，陕西 西安 710032 |
| 吕小慧1 | 1. 空军军医大学第一附属医院妇产科，陕西 西安 710032 |
| 马佳佳1 | 1. 空军军医大学第一附属医院妇产科，陕西 西安 710032 |
| 郇宇2 | 2. 空军军医大学，陕西 西安 710038 |
引用文本：
李玲霞,刘淑娟,吕小慧,等.宫颈小细胞神经内分泌癌24例临床分析[J].中国临床研究,2022,35(3):325-329.
李玲霞,刘淑娟,吕小慧,等.宫颈小细胞神经内分泌癌24例临床分析[J].中国临床研究,2022,35(3):325-329.