Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; National Clinical research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Wuhan, Hubei, China.
Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Lancet Oncol. 2023 Jun;24(6):701-708. doi: 10.1016/S1470-2045(23)00185-7.
Small cell carcinoma of the cervix is a rare but poor prognosis pathological type of cervical cancer, for which advice in clinical guidelines is unspecific. We therefore aimed to investigate the factors and treatment methods that affect the prognosis of patients with small cell carcinoma of the cervix.
In this retrospective study, we collected data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries cohort and a Chinese multi-institutional registry. The SEER cohort included females diagnosed with small cell carcinoma of the cervix between Jan 1, 2000, and Dec 31, 2018, whereas the Chinese cohort included women diagnosed between Jun 1, 2006, and April 30, 2022. In both cohorts, eligibility was limited to female patients older than 20 years with a confirmed diagnosis of small cell carcinoma of the cervix. Participants who were lost to follow-up or those for whom small cell carcinoma of the cervix was not the primary malignant tumour were excluded from the multi-institutional registry, and those with an unknown surgery status (in addition to those for whom small cell carcinoma of the cervix was not the primary malignant tumour) were excluded from the SEER data. The primary outcome of this study was overall survival (length of time from the date of first diagnosis until the date of death from any cause, or the last follow-up). Kaplan-Meier analysis, propensity score matching, and Cox-regression analyses were used to assess treatment outcomes and risk factors.
1288 participants were included in the study; 610 in the SEER cohort and 678 in the Chinese cohort. Both univariable and multivariable Cox regression analysis (SEER hazard ratio [HR] 0·65 [95% CI 0·48-0·88], p=0·0058; China HR 0·53 [0·37-0·76], p=0·0005) showed that surgery was associated with a better prognosis. In subgroup analyses, surgery remained a protective factor for patients with locally advanced disease in both cohorts (SEER HR 0·61 [95% CI 0·39-0·94], p=0·024; China HR 0·59 [0·37-0·95]; p=0·029). Furthermore, the protective effect of surgery was observed among patients with locally advanced disease after propensity score matching in the SEER cohort (HR 0·52 [95% CI 0·32-0·84]; p=0·0077). In the China registry, surgery was associated with better outcomes in patients with stage IB3-IIA2 cancer (HR 0·17 [95% CI 0·05-0·50]; p=0·0015).
This study provides evidence that surgery improves outcomes of patients with small cell carcinoma of the cervix. Although guidelines recommend non-surgical methods as first-line treatment, patients with locally advanced disease or stage IB3-IIA2 cancer might benefit from surgery.
The National Key R&D Program of China and the National Natural Science Foundation of China.
小细胞宫颈癌是一种罕见但预后较差的宫颈癌病理类型，临床指南对此建议不明确。因此，我们旨在研究影响小细胞宫颈癌患者预后的因素和治疗方法。
在这项回顾性研究中，我们从监测、流行病学和最终结果（SEER）18 个登记处队列和一个中国多机构登记处收集数据。SEER 队列纳入 2000 年 1 月 1 日至 2018 年 12 月 31 日期间确诊为小细胞宫颈癌的女性；中国队列纳入 2006 年 6 月 1 日至 2022 年 4 月 30 日期间确诊的女性。两个队列的纳入标准均为年龄大于 20 岁、经确认诊断为小细胞宫颈癌的女性。排除随访丢失或小细胞宫颈癌不是主要恶性肿瘤的患者（中国队列），以及手术状态未知（此外还排除小细胞宫颈癌不是主要恶性肿瘤的患者）的患者（SEER 数据）。本研究的主要结局是总生存（从首次诊断日期到任何原因死亡或最后一次随访的时间）。Kaplan-Meier 分析、倾向评分匹配和 Cox 回归分析用于评估治疗结果和风险因素。
共纳入 1288 名参与者；SEER 队列 610 名，中国队列 678 名。单变量和多变量 Cox 回归分析（SEER 风险比[HR]0·65[95%CI 0·48-0·88]，p=0·0058；中国 HR 0·53[0·37-0·76]，p=0·0005）表明手术与更好的预后相关。亚组分析显示，手术在两个队列中均为局部晚期疾病患者的保护因素（SEER HR 0·61[95%CI 0·39-0·94]，p=0·024；中国 HR 0·59[0·37-0·95]；p=0·029）。此外，在 SEER 队列的倾向评分匹配后，手术对局部晚期疾病患者的保护作用也得到了观察（HR 0·52[95%CI 0·32-0·84]；p=0·0077）。在中国登记处，手术与 IB3 期-IIA2 期癌症患者的更好结局相关（HR 0·17[95%CI 0·05-0·50]；p=0·0015）。
本研究提供了证据表明手术可改善小细胞宫颈癌患者的预后。尽管指南建议将非手术方法作为一线治疗方法，但局部晚期疾病或 IB3 期-IIA2 期癌症患者可能受益于手术。
国家重点研发计划和国家自然科学基金。
