Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
Gynecol Oncol. 2018 Jan;148(1):139-146. doi: 10.1016/j.ygyno.2017.10.027. Epub 2017 Nov 4.
We aimed to determine appropriate treatment guidelines for patients with stages I-II high-grade neuroendocrine carcinomas (HGNEC) of the uterine cervix in a multicenter retrospective study.
We reviewed the clinicopathological features and prognoses of 93 patients with HGNEC of International Federation of Gynecology and Obstetrics (FIGO) stages I and II. All patients were diagnosed with HGNEC by central pathological review.
The median overall survival (OS) and disease-free survival (DFS) were 111.3months and 47.4months, respectively. Eighty-eight patients underwent radical surgery, and five had definitive radiotherapy. The hazard ratio (HR) for death after definitive radiotherapy to death after radical surgery was 4.74 (95% confidence interval [CI], 1.01-15.90). Of the surgery group, 18 received neoadjuvant chemotherapy. Pathological prognostic factors and optimal adjuvant therapies were evaluated for the 70 patients. Forty-one patients received adjuvant chemotherapy with etoposide-platinum (EP) or irinotecan-platinum (CPT-P). Multivariate analyses identified the invasion of lymphovascular spaces as a significant prognostic factor for both OS and DFS. Pelvic lymph node metastasis was also a prognostic factor for DFS. Adjuvant chemotherapy with an EP or CPT-P regimen appeared to improve DFS (HR=0.27, 95% CI, 0.10-0.69). A trend toward improved OS was also observed, but was not statistically significant (HR=0.39, 95% CI, 0.15-1.01).
Radical surgery followed by adjuvant chemotherapy with an EP or CPT-P regimen was optimal treatment for stages I and II HGNEC of the uterine cervix.
我们旨在通过一项多中心回顾性研究，为国际妇产科联合会（FIGO）分期 I 和 II 期的子宫颈高级别神经内分泌癌（HGNEC）患者确定适当的治疗指南。
我们回顾了 93 例 HGNEC 患者的临床病理特征和预后，这些患者均经中心病理复查诊断为 HGNEC。
中位总生存期（OS）和无病生存期（DFS）分别为 111.3 个月和 47.4 个月。88 例患者接受了根治性手术，5 例患者接受了根治性放疗。根治性放疗后死亡的风险比（HR）为 4.74（95%置信区间[CI]，1.01-15.90），显著高于根治性手术后死亡的 HR。手术组中有 18 例接受了新辅助化疗。对 70 例患者进行了病理预后因素和最佳辅助治疗的评估。41 例患者接受了依托泊苷-铂（EP）或伊立替康-铂（CPT-P）辅助化疗。多变量分析确定淋巴血管空间浸润是 OS 和 DFS 的显著预后因素。盆腔淋巴结转移也是 DFS 的预后因素。EP 或 CPT-P 方案的辅助化疗似乎改善了 DFS（HR=0.27，95%CI，0.10-0.69）。OS 也有改善的趋势，但无统计学意义（HR=0.39，95%CI，0.15-1.01）。
对于子宫颈 I 期和 II 期 HGNEC，根治性手术联合 EP 或 CPT-P 方案的辅助化疗是最佳治疗方法。
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