Song X C, Zhang H, Zhong S, Tan X J, Ma S Q, Jin Y, Pan L Y, Wu M, Cao D Y, Yang J X, Xiang Y
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2024 Mar 25;59(3):200-209. doi: 10.3760/cma.j.cn112141-20230918-00106.
To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) . This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. (1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24); =1.296, =0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24); =0.001, =0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24); =0.113, =0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference (=0.080, =0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences (=0.287, =0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9%; =0.138) and 5-year OS rate (36.1% vs 38.8%; =0.217). Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.
评估手术联合化疗及放疗用于局部晚期子宫颈神经内分泌癌（NECC）的疗效。这是一项单中心回顾性队列研究。纳入2011年1月至2022年4月在中国医学科学院北京协和医院收治的局部晚期NECC患者。将其分为同步放化疗组和手术联合化疗及放疗组。采用Kaplan-Meier法分析无进展生存期（PFS）、总生存期（OS）、复发率和死亡率。（1）共纳入46例患者，同步放化疗组22例，手术联合化疗及放疗组24例。16例患者（35%，16/46）接受了新辅助化疗（NACT），NACT有效率为15/16。（2）中位随访时间为27.5个月（范围：10 - 106个月），46例中有26例（57%，26/46）复发。盆腔复发4例（9%，4/46），远处复发25例（54%，25/46），盆腔及远处均复发3例（7%，3/46）。与同步放化疗组相比，手术联合化疗及放疗组盆腔复发率较低[14%（3/22）对4%（1/24）；χ² = 1.296，P = 0.255]，但无统计学差异。两组远处复发率[55%（12/22）对54%（13/24）；χ² = 0.001，P = 0.979]和总复发率[59%（13/22）对54%（13/24）；χ² = 0.113，P = 0.736]相似。（3）随访期间，46例中有22例（48%，22/46）死亡，同步放化疗组11例（50%，11/22），手术联合化疗及放疗组11例（46%，11/24），无显著差异（χ² = 0.080，P = 0.777）。术后3年和5年OS率分别为62.3%和36.9%。与同步放化疗组相比，手术联合化疗及放疗组患者的PFS（17.0对32.0个月）和OS（37.0对50.0个月）呈延长趋势，但无统计学差异（χ² = 0.287，P = 0.125）。两组3年OS率（54.2%对69.9%；χ² = 0.138）和5年OS率（36.1%对38.8%；χ² = 0.217）相似。我们的研究支持多模式治疗策略（包括手术（、化疗和放疗）作为局部晚期NECC治疗的重要组成部分。手术、化疗和放疗联合应用在局部晚期NECC治疗中似乎具有优势，但需要进一步的多中心研究予以证实。
