目的:评估经手术治疗的高级别宫颈神经内分泌癌(NECC)患者的预后因素和生存结果。
方法:这个多中心,回顾性研究纳入了98例IA2-IIA2和IIIC1/2p高级别NECC宫颈癌患者.我们根据组织学将患者分为两组:单纯组和混合组。对所有临床病理变量进行回顾性评估。采用Cox回归和Kaplan-Meier方法进行分析。
结果:在我们的研究中,纯真组60例,混杂组38例。Cox多变量分析显示,在手术治疗的高级别NECC中,混合组织学是影响总生存期(OS)(P=0.026)和无进展生存期(PFS)(P=0.018)的保护因素。相反,保留卵巢对生存结果产生负面影响(OS:HR,20.84;95%CI:5.02-86.57,P<0.001),年龄>45岁(操作系统:HR,4.50;95%CI:1.0-18.83,P=0.039),肿瘤大小>4厘米(OS:HR,6.23;95%CI:2.34-16.61,P<0.001),奇偶校验>3(操作系统:HR,4.50;95%CI:1.02-19.91,P=0.048),和神经周侵犯(OS:HR,5.21;95%CI:1.20-22.53,P=0.027)。Kaplan-Meier存活曲线显示组织学类型存在显着差异(OS:P=0.045;PFS:P=0.024),化疗(OS:P=0.0056;PFS:P=0.0041),卵巢保存(OS:P=0.00031;PFS:P=0.0023),子宫侵犯(OS:P<0.0001;PFS:P<0.0001),基质浸润深度(OS:P=0.043;PFS:P=0.022)。
结论:接受高级别NECC手术的混合组织学类型患者预后较好。同时,卵巢保存,肿瘤大小>4厘米,胎次>3,年龄>45岁和神经周浸润是预后不良的预测因素。因此,在临床实践中应考虑高危因素患者。
OBJECTIVE: To evaluate the prognostic factors and survival outcomes of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix (NECC).
METHODS: This multicenter, retrospective study involved 98 cervical cancer patients with stage IA2-IIA2 and IIIC1/2p high-grade NECC. We divided the patients into two groups based on histology: the pure and mixed groups. All clinicopathologic variables were retrospectively evaluated. Cox regression and Kaplan-Meier methods were used for analysis.
RESULTS: In our study, 60 patients were in the pure group and 38 patients were in the mixed group. Cox multivariate analysis showed that mixed histology was a protective factor impacting overall survival (OS) (P = 0.026) and progression free survival (PFS) (P = 0.018) in surgically treated high-grade NECC. Conversely, survival outcomes were negatively impacted by ovarian preservation (OS: HR, 20.84; 95% CI: 5.02-86.57, P < 0.001), age >45 years (OS: HR, 4.50; 95% CI: 1.0-18.83, P = 0.039), tumor size >4 cm (OS: HR, 6.23; 95% CI: 2.34-16.61, P < 0.001), parity >3 (OS: HR, 4.50; 95% CI: 1.02-19.91, P = 0.048), and perineural invasion (OS: HR, 5.21; 95% CI: 1.20-22.53, P = 0.027). Kaplan-Meier survival curves revealed notable differences in histologic type (OS: P = 0.045; PFS: P = 0.024), chemotherapy (OS: P = 0.0056; PFS: P = 0.0041), ovarian preservation (OS: P = 0.00031; PFS: P = 0.0023), uterine invasion (OS: P < 0.0001; PFS: P < 0.0001), and depth of stromal invasion (OS: P = 0.043; PFS: P = 0.022).
CONCLUSIONS: Patients with mixed histologic types who undergo surgery for high-grade NECC have a better prognosis. Meanwhile, ovarian preservation, tumor size >4 cm, parity >3, age >45 years and perineural invasion were poor prognostic predictors. Therefore, patients with high-risk factors should be considered in clinical practice.