Zhang Yuanyuan, Li Lin, Wang Ziyi, Huang Yi, Luo Suiyu, Peng Yongmei, Li Ning, He Yang, Li Chunmei, Zhang Keqiang, Yang Hongying, Zhou Qi, Wu Lingying
Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College 17 Panjiayuan, Chaoyang District, Beijing 100021, China.
Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital Chongqing 400030, China.
Am J Cancer Res. 2021 Sep 15;11(9):4595-4606. eCollection 2021.
High-grade neuroendocrine carcinoma of the uterine cervix (HGNECC) is a rare and overly aggressive malignancy. Due to its rarity, there is no standard treatment. A majority of early-stage patients receive radical hysterectomy and lymph node dissection (RH+LND), followed by adjuvant chemotherapy. To explore the most suitable methods of therapy, a multicenter retrospective review of HGNECC patients was conducted. A total of 133 patients (I-IIA, FIGO 2009) treated from March 2003 to September 2018 were enrolled in this study. The 5-year DFS and OS rates for stages IB and IIA were 44.8% and 39.5%, and 53.8% and 39.6%, respectively. The median DFS and OS for stages IB and IIA were 41 months and 12 months, and 63 months and 45 months, respectively. The RH+LND surgery procedure was associated with a significantly better DFS (=0.015) and OS (=0.006), while the bilateral salpingo-oophorectomy (BSOE) was also associated with a better OS (=0.023). The efficacy of paclitaxel-platinum (TP/C) adjuvant chemotherapy regimens need to be confirmed using clinical trials, especially for tumors with a diameter of >4 cm (=0.0005). Therefore, the RH+LND+BSOE procedure was recommended for HGNECC patients at stages IB-IIA. TP/C is an alternative chemotherapy regimen that results in optimal survival. Moreover, a tumor diameter of >4 cm, LNM, DSI, and LVSI were confirmed as high-risk factors for worse DFS and OS. Patients without risk factor, 1 or 2 or 3 risk factors, and 4 risk factors had significantly different DFS and OS values.
子宫颈高级别神经内分泌癌（HGNECC）是一种罕见且侵袭性极强的恶性肿瘤。由于其罕见性，目前尚无标准治疗方案。大多数早期患者接受根治性子宫切除术和淋巴结清扫术（RH+LND），随后进行辅助化疗。为探索最合适的治疗方法，对HGNECC患者进行了多中心回顾性研究。本研究纳入了2003年3月至2018年9月期间治疗的133例患者（I-IIA期，国际妇产科联盟（FIGO）2009分期）。IB期和IIA期的5年无病生存率（DFS）和总生存率（OS）分别为44.8%和39.5%，以及53.8%和39.6%。IB期和IIA期的中位DFS和OS分别为41个月和12个月，以及63个月和45个月。RH+LND手术与显著更好的DFS（P=0.015）和OS（P=0.006）相关，而双侧输卵管卵巢切除术（BSOE）也与更好的OS相关（P=0.023）。紫杉醇-铂类（TP/C）辅助化疗方案的疗效需要通过临床试验来证实，尤其是对于直径>4 cm的肿瘤（P=0.0005）。因此，对于IB-IIA期的HGNECC患者，推荐采用RH+LND+BSOE手术。TP/C是一种可使生存率达到最佳的替代化疗方案。此外，肿瘤直径>4 cm、淋巴结转移（LNM）、深部间质浸润（DSI）和脉管间隙浸润（LVSI）被确认为DFS和OS较差的高危因素。无危险因素、有1个或2个或3个危险因素以及有4个危险因素的患者，其DFS和OS值存在显著差异。
