Arango-Bravo Eder Alexandro, Galicia-Carmona Tatiana, Cetina-Pérez Lucely, Flores-de la Torre Celia Beatriz, Enríquez-Aceves María Isabel, García-Pacheco José Antonio, Gómez-García Eva María
Medical Oncology Department, National Institute of Cancerology (INCan), Mexico City, Mexico.
Clinical Investigation Department, National Institute of Cancerology (INCan), Mexico City, Mexico.
Front Oncol. 2024 Jun 28;14:1386294. doi: 10.3389/fonc.2024.1386294. eCollection 2024.
The objective of this review is to summarize the current scientific evidence to formulate clinical recommendations regarding the classification, diagnostic approach, and treatment of rare histological subtypes of cervical cancer; neuroendocrine carcinoma, gastric-type mucinous adenocarcinoma, and glassy cell adenocarcinoma. These histological subtypes are generally characterized by their low frequency, aggressive biological behavior, certain chemoradioresistance, and consequently, high recurrence rates with a deleterious impact on survival. Molecular studies have identified several associated mutations in neuroendocrine carcinoma (PIK3CA, MYC, TP53, PTEN, ARID1A, KRAS, BRCA2) and gastric-type adenocarcinoma (KRAS, ARID1A, PTEN) that may serve as molecular targets. While adenocarcinomas are typically treated and classified based on squamous histology across early, locally advanced, and advanced stages, the treatment strategies for neuroendocrine carcinomas in early stages or locally advanced cases differ, particularly in the sequencing of administering chemotherapy, chemoradiotherapy, or surgery. The chemotherapy regimen is based on etoposide plus cisplatin (EP). Unlike squamous cell carcinomas, immune checkpoint inhibitors are yet to establish a standard role in the treatment of recurrent neuroendocrine carcinomas due to the absence of clinical trials. Regarding glassy cell adenocarcinomas and gastric-type adenocarcinoma, the potential use of immunotherapy in advanced stages/disease requires further evaluation through international collaborations, given the limited number of cases.
本综述的目的是总结当前的科学证据，以制定关于宫颈癌罕见组织学亚型（神经内分泌癌、胃型黏液腺癌和透明细胞腺癌）的分类、诊断方法和治疗的临床建议。这些组织学亚型的一般特征是发病率低、生物学行为侵袭性强、具有一定的放化疗抵抗性，因此复发率高，对生存率有不利影响。分子研究已在神经内分泌癌（PIK3CA、MYC、TP53、PTEN、ARID1A、KRAS、BRCA2）和胃型腺癌（KRAS、ARID1A、PTEN）中鉴定出几种相关突变，这些突变可能作为分子靶点。虽然腺癌通常根据鳞状组织学在早期、局部晚期和晚期进行治疗和分类，但早期或局部晚期神经内分泌癌的治疗策略有所不同，特别是在化疗、放化疗或手术的给药顺序方面。化疗方案基于依托泊苷加顺铂（EP）。与鳞状细胞癌不同，由于缺乏临床试验，免疫检查点抑制剂在复发性神经内分泌癌的治疗中尚未确立标准作用。鉴于病例数量有限，对于透明细胞腺癌和胃型腺癌，晚期/疾病中免疫疗法的潜在应用需要通过国际合作进行进一步评估。
