Pei Xuan, Xiang Libing, Ye Shuang, He Tiancong, Cheng Yufan, Yang Wentao, Wu Xiaohua, Yang Huijuan
Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Gynecol Oncol. 2017 Dec;147(3):589-596. doi: 10.1016/j.ygyno.2017.09.022. Epub 2017 Sep 24.
This study sought to explore the outcomes and prognostic factors of patients with small cell neuroendocrine carcinoma of the cervix (SCNEC) and to determine the effects of adjuvant treatment on survival in patients with FIGO stage I-II SCNEC after radical surgery.
A single-institution retrospective analysis was performed in 92 patients who underwent radical surgery for SCNEC. All clinicopathological variables and treatment strategies were reviewed. Kaplan-Meier and Cox regression methods were used for survival analyses.
During a median follow-up period of 38months (23.6-52.4), 43 (46.7%) patients experienced disease recurrence, and distant metastases were documented in 35 (81.4%) patients. The 3-year recurrence-free survival (RFS) for the entire group was 50.1%. The median RFS was 39months. The multivariate analysis confirmed that lymph node metastasis, positive parametrial extension and cycles of etoposide plus platinum (EP) were independent prognostic factors for disease recurrence. Adjuvant chemotherapy for at least 5cycles of EP (EP 5+, n=39) was associated with improved 5-year RFS compared with other treatments (n=46) (67.6% vs. 20.9%, p<0.001). Additional radiotherapy or concurrent chemoradiation failed to validate further improved RFS in patients with EP 5+, and this finding was consistent in the subset of patients with high-risk factors (positive lymph nodes or positive parametrium).
Half of stage I-II SCNEC patients experienced disease failure within 3years, and distant metastasis was an outstanding issue. EP regimen for at least 5cycles improved long-term RFS after radical surgery. Additional radiation might be unnecessary, even in patients with high-risk factors.
本研究旨在探讨宫颈小细胞神经内分泌癌（SCNEC）患者的治疗结果及预后因素，并确定辅助治疗对FIGO I-II期SCNEC患者根治性手术后生存的影响。
对92例行SCNEC根治性手术的患者进行单中心回顾性分析。回顾了所有临床病理变量和治疗策略。采用Kaplan-Meier法和Cox回归法进行生存分析。
在中位随访期38个月（23.6 - 52.4个月）内，43例（46.7%）患者出现疾病复发，35例（81.4%）患者有远处转移记录。全组3年无复发生存率（RFS）为50.1%。中位RFS为39个月。多因素分析证实，淋巴结转移、宫旁组织阳性浸润及依托泊苷联合铂类（EP）化疗周期数是疾病复发的独立预后因素。与其他治疗组（n = 46）相比，至少接受5周期EP辅助化疗（EP 5 +，n = 39）的患者5年RFS有所改善（67.6% vs. 20.9%，p < 0.001）。对于EP 5 +的患者，额外放疗或同步放化疗未能进一步证实RFS得到改善，这一结果在具有高危因素（淋巴结阳性或宫旁阳性）的患者亚组中也是一致的。
I-II期SCNEC患者中有一半在3年内出现疾病进展，远处转移是一个突出问题。根治性手术后，至少5周期的EP方案可改善长期RFS。即使是具有高危因素的患者，额外放疗可能也无必要。
