Pang Li, Guo Zhiqiang
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Front Oncol. 2022 May 4;12:891699. doi: 10.3389/fonc.2022.891699. eCollection 2022.
Owing to its extremely low incidence and the paucity of relevant reports, there is currently no recognized first-line treatment strategy for ovarian large-cell neuroendocrine carcinoma, and there are no statistics related to prognosis derived from large samples. This study aimed to investigate the characteristics, outcomes, and independent predictors of survival for ovarian large-cell neuroendocrine carcinoma and compare them with those of high-grade serous ovarian cancer.
The Surveillance, Epidemiology, and End Results database was used to identify women diagnosed with ovarian large-cell neuroendocrine carcinoma or high-grade serous ovarian cancer from 1988 to 2015. Clinical, demographic, and treatment characteristics were compared between the groups. Propensity-score matching, Cox risk regression analysis, and Kaplan-Meier survival curves were used to analyze the data.
In total, 23,917 women, including 23,698 (99.1%) diagnosed with high-grade serous ovarian cancer and 219 (0.9%) diagnosed with ovarian large-cell neuroendocrine carcinoma, were identified. Age >77 years, diagnosis before 2003-2010, and advanced-stage disease were more common in patients with ovarian large-cell neuroendocrine carcinoma than in those with high-grade serous ovarian cancer. Women with ovarian large-cell neuroendocrine carcinoma were less likely to receive adjuvant chemotherapy (54.8% vs. 81.9%) but more likely to receive radiotherapy (3.2% vs. 1.5%; both P<0.001) than women with high-grade serous ovarian cancer. Stage, chemotherapy, and tumor size were independent predictors of overall survival, and the risk of death was greater in the advanced stage than in the early stage (P=0.047). Chemotherapy and tumor size were also independent predictors of cancer-specific survival. Overall and cancer-specific survival rates were significantly low for ovarian large-cell neuroendocrine carcinoma than for more malignant high-grade serous ovarian cancer.
Compared to patients with high-grade serous ovarian cancer, those with ovarian large-cell neuroendocrine carcinoma presented more often with advanced-stage disease and had decreased overall and cancer-specific survival rates.
由于卵巢大细胞神经内分泌癌的发病率极低且相关报道匮乏，目前尚无公认的一线治疗策略，也没有来自大样本的预后统计数据。本研究旨在调查卵巢大细胞神经内分泌癌的特征、结局及生存的独立预测因素，并将其与高级别浆液性卵巢癌进行比较。
利用监测、流行病学和最终结果数据库，识别出1988年至2015年期间被诊断为卵巢大细胞神经内分泌癌或高级别浆液性卵巢癌的女性。比较两组的临床、人口统计学和治疗特征。采用倾向评分匹配、Cox风险回归分析和Kaplan-Meier生存曲线对数据进行分析。
共识别出23917名女性，其中23698名（99.1%）被诊断为高级别浆液性卵巢癌，219名（0.9%）被诊断为卵巢大细胞神经内分泌癌。与高级别浆液性卵巢癌患者相比，卵巢大细胞神经内分泌癌患者年龄>77岁、2003 - 2010年前诊断以及晚期疾病更为常见。与高级别浆液性卵巢癌女性相比，卵巢大细胞神经内分泌癌女性接受辅助化疗的可能性较小（54.8%对81.9%），但接受放疗的可能性较大（3.2%对1.5%；P均<0.001）。分期、化疗和肿瘤大小是总生存的独立预测因素，晚期死亡风险高于早期（P = 0.047）。化疗和肿瘤大小也是癌症特异性生存的独立预测因素。卵巢大细胞神经内分泌癌的总生存率和癌症特异性生存率显著低于恶性程度更高的高级别浆液性卵巢癌。
与高级别浆液性卵巢癌患者相比，卵巢大细胞神经内分泌癌患者晚期疾病更为常见，总生存率和癌症特异性生存率降低。
