University of Colorado Denver, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, CO 80045, USA.
Gynecol Oncol. 2011 Mar;120(3):444-8. doi: 10.1016/j.ygyno.2010.11.007. Epub 2010 Dec 7.
Large cell neuroendocrine carcinoma of the cervix (LCNEC) is a rare cervical neoplasm associated with poor survival. Our objective was to identify treatments associated with improved survival.
Relevant data were abstracted from an English literature MEDLINE search, SEER database, and a patient treated at our institution. Multivariate analysis was performed by generating Cox proportional hazard ratios.
We identified 62 patients with LCNEC: 49 cases from the English literature, 12 patients in the SEER database and our patient. Out of the 62 women, median age was 37 (range, 21-75). FIGO stage was as follows: 58% had stage I disease, 16% had stage II, 2% had stage III, 8% had stage IV disease and 16% had no stage documented. Of all patients, 73% underwent primary surgery, 4.7% underwent primary radiation, 4.7% underwent chemotherapy, 8% had chemoradiation, and 9.6% had no primary treatment. Of all patients, 58% died of disease, 26% had no evidence of disease, 3% were alive with disease, and 13% had no survival data. The overall median survival was 16.5 months (0.5-151 months). Median overall survival for stage I, II, III, and IV cancers was 19, 17, 3, and 1.5 months, respectively. In a multivariate analysis, earlier stage (p<0.00001) and the addition of chemotherapy (p=0.04) were associated with improved survival. Both platinum agents (p=0.034) and platinum and etoposide together (p=0.027) were associated with improved survival.
Perioperative chemotherapy, in particular platinum with or without etoposide, improves survival in the rare LCNEC.
宫颈大细胞神经内分泌癌（LCNEC）是一种罕见的宫颈肿瘤，与生存预后不良相关。本研究旨在确定改善生存预后的治疗方法。
本研究通过英文文献 MEDLINE 检索、SEER 数据库以及本机构治疗的患者，提取相关数据。采用 Cox 比例风险比进行多变量分析。
共纳入 62 例 LCNEC 患者：49 例来自英文文献，12 例来自 SEER 数据库，1 例为本机构患者。62 例患者的中位年龄为 37 岁（范围 21-75 岁）。FIGO 分期如下：Ⅰ期 58%，Ⅱ期 16%，Ⅲ期 2%，Ⅳ期 8%，无法分期 16%。所有患者中，73%接受了初始手术，4.7%接受了初始放疗，4.7%接受了化疗，8%接受了放化疗，9.6%未接受初始治疗。所有患者中，58%因疾病死亡，26%无疾病证据，3%疾病仍在进展，13%无生存数据。总中位生存时间为 16.5 个月（0.5-151 个月）。Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期癌症的总中位生存时间分别为 19、17、3 和 1.5 个月。多变量分析显示，早期分期（p<0.00001）和化疗的加入（p=0.04）与生存改善相关。顺铂类药物（p=0.034）和顺铂联合依托泊苷（p=0.027）均可改善生存。
围手术期化疗，特别是顺铂联合或不联合依托泊苷，可改善罕见的 LCNEC 患者的生存预后。
