手术治疗后辅助化疗的小细胞宫颈癌的预后因素

Prognostic factors in surgically treated small cell cervical carcinoma followed by adjuvant chemotherapy.

作者信息

Chang T C, Lai C H, Tseng C J, Hsueh S, Huang K G, Chou H H

机构信息

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.

出版信息

Cancer. 1998 Aug 15;83(4):712-8. doi: 10.1002/(sici)1097-0142(19980815)83:4<712::aid-cncr12>3.0.co;2-v.

DOI:10.1002/(sici)1097-0142(19980815)83:4<712::aid-cncr12>3.0.co;2-v

PMID:9708935

Abstract

BACKGROUND

Small cell carcinoma of the uterine cervix is an uncommon tumor associated with high mortality even among patients with early stage disease. The role of adjuvant chemotherapy after surgery has been suggested by regimens used for small cell lung carcinoma. During the years 1980-1997, 19 cases in which various adjuvant chemotherapies were given after hysterectomy were reported in the literature published in English.

METHODS

Adjuvant chemotherapy was administered consecutively to 23 patients with Stage Ib-II small cell cervical carcinoma who had been primarily treated with radical hysterectomy and had adequate bone marrow, renal, and hepatic functions. A combination of vincristine, doxorubicin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE) was administered to 14 patients during the years 1988-1996 according to a prospective study protocol. A combination of cisplatin, vinblastine, and bleomycin (PVB) was administered to 8 patients, and another regimen was administered to 1 patient during the years 1984-1988. Prognostic factors were evaluated by analyzing both the data on these 23 patients and the pooled data on the cases retrieved from the literature and our own files.

RESULTS

Ten of the 14 patients who received VAC/PE had no evidence of disease during a median follow-up of 41 months, whereas 3 of the 9 who received PVB or another regimen survived. Of the 10 patients who died of their disease, all died of distant metastasis within 10 months after recurrence. Meta-analysis of the pooled data showed that 68% of patients who received regimens containing VAC or PE survived, whereas 33% of patients who received regimens not containing VAC/PE survived (P = 0.0078, log rank test). Seventy percent of patients with no lymph node metastasis at hysterectomy and 35% with lymph node metastasis survived (P = 0.05). All patients who died of disease had extrapelvic metastasis.

CONCLUSIONS

Chemotherapies containing VAC or PE are favorable regimens for patients with early stage small cell cervical carcinoma after radical hysterectomy.

摘要

背景

子宫颈小细胞癌是一种罕见肿瘤，即使在疾病早期患者中死亡率也很高。小细胞肺癌所用的治疗方案提示了手术后辅助化疗的作用。1980年至1997年间，英文文献报道了19例子宫切除术后接受各种辅助化疗的病例。

方法

连续对23例Ib-II期子宫颈小细胞癌患者进行辅助化疗，这些患者最初接受了根治性子宫切除术，且骨髓、肾脏和肝功能良好。根据一项前瞻性研究方案，1988年至1996年间，14例患者接受了长春新碱、阿霉素和环磷酰胺联合顺铂和依托泊苷（VAC/PE）的交替治疗。1984年至1988年间，8例患者接受了顺铂、长春碱和博来霉素联合治疗（PVB），1例患者接受了另一种治疗方案。通过分析这23例患者的数据以及从文献和我们自己的病例档案中检索到的病例的汇总数据来评估预后因素。

结果

接受VAC/PE治疗的14例患者中，10例在中位随访41个月期间无疾病证据，而接受PVB或其他治疗方案的9例患者中有3例存活。10例死于该疾病的患者均在复发后10个月内死于远处转移。汇总数据的荟萃分析显示，接受含VAC或PE方案治疗的患者68%存活，而接受不含VAC/PE方案治疗的患者33%存活（P = 0.0078，对数秩检验）。子宫切除时无淋巴结转移的患者70%存活，有淋巴结转移的患者35%存活（P = 0.05）。所有死于该疾病的患者均有盆腔外转移。