*Boromarajonnani College of Nursing, Khon Kaen; †Faculty of Nursing, and ‡Department of Pathology, Faculty of Medicine, Chiang Mai University; §Department of Gynecology and Obstetrics, Nakornping Hospital; and ∥Clinical Epidemiology Unit, Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Gynecol Cancer. 2014 Feb;24(2):272-9. doi: 10.1097/IGC.0000000000000059.
This study aimed to determine the clinicopathologic characteristics that affected the survival in patients with small cell neuroendocrine carcinoma of the uterine cervix (SNEC).
All patients with SNEC treated at Chiang Mai University Hospital between January 1995 and October 2011 were retrospectively reviewed with histologic confirmation of SNEC diagnosis. The prognostic predictors for survival were assessed using competing risk regression analysis concerning the probabilities of competing events.
One hundred thirty histologically confirmed patients with SNEC met the study criteria. The median overall survival and median cancer-specific survival (CSS) for entire group were 47.8 and 58.1 months, respectively. Five-year CSS for patients with early-stage disease was 62.6% and for patients with advanced-stage disease was 18.1% (P < 0.001). Among the patients with surgically treated early-stage disease, those with adjuvant chemotherapy had a better 5-year survival rate than those with surgery alone, those with adjuvant radiotherapy, and those with adjuvant chemoradiation therapy (P = 0.041). In multivariable analyses, decreased survival in patients with early-stage disease was associated with age older than 60 years at diagnosis (hazards ratio [HR], 4.9; P = 0.007) and deep stromal invasion (HR, 2.9; P = 0.011). Among the patients with advanced-stage disease, decreased survival was associated with age at diagnosis (older than 60 years: HR, 9.9; P < 0.001 and younger than 45 years: HR, 3.4; P = 0.035) and International Federation of Gynecology and Obstetrics stage IV (HR, 7.4; P = 0.024).
International Federation of Gynecology and Obstetrics stage, age at diagnosis, and deep stromal invasion were important prognostic factors for CSS in patients with SNEC. Adjuvant chemotherapy may provide survival benefits in surgically treated patients with early-stage SNEC.
本研究旨在确定影响宫颈小细胞神经内分泌癌（SNEC）患者生存的临床病理特征。
回顾性分析了 1995 年 1 月至 2011 年 10 月在清迈大学医院接受治疗的所有 SNEC 患者，所有患者均经组织学证实为 SNEC 诊断。使用竞争风险回归分析评估生存的预后预测因子，考虑竞争事件的概率。
130 例经组织学证实的 SNEC 患者符合研究标准。全组患者的中位总生存和中位癌症特异性生存（CSS）分别为 47.8 个月和 58.1 个月。早期疾病患者的 5 年 CSS 为 62.6%，晚期疾病患者为 18.1%（P<0.001）。在接受手术治疗的早期疾病患者中，与单独手术相比，接受辅助化疗的患者、接受辅助放疗的患者和接受辅助放化疗的患者 5 年生存率更高（P=0.041）。多变量分析显示，早期疾病患者生存时间缩短与诊断时年龄大于 60 岁（危险比[HR]，4.9；P=0.007）和深肌层浸润（HR，2.9；P=0.011）有关。在晚期疾病患者中，生存时间缩短与诊断时年龄有关（大于 60 岁：HR，9.9；P<0.001；小于 45 岁：HR，3.4；P=0.035）和国际妇产科联合会（FIGO）分期 IV 期（HR，7.4；P=0.024）。
FIGO 分期、诊断时年龄和深肌层浸润是 SNEC 患者 CSS 的重要预后因素。辅助化疗可能为接受手术治疗的早期 SNEC 患者提供生存获益。
