目的 探讨宫颈小细胞神经内分泌癌(small cell neuroendocrine carcinoma，SCNEC)的远转模式与预后。方法 回顾性分析美国国家癌症研究所监测、流行病学和最终结果(SEER)数据库中2000年1月至2018年12月确诊为宫颈SCNEC 285例的临床资料。采用Kaplan-Meier法计算总生存时间(overall survival，OS)，log-rank检验组间差异，Cox比例风险回归模型进行单因素及多因素分析，以评估原发肿瘤(T)、区域淋巴结(N)和远处转移(M)等不同变量对预后的影响。结果 在描述了特定转移部位的35例SCNEC中，肝脏是最常见的转移部位(n=7，20。0％)。有远处器官转移(M1)组患者的中位OS明显低于无远处转移(M0)组(27个月vs 10个月，P＜0。001)。年龄>40岁、黑色人种、T4、N1、M1、原发部位未手术和未化疗是OS的独立预后不良因素(P均＜0。05)。与未接受原发部位手术(化疗)相比，接受原发部位手术(化疗)的中位OS显著延长(手术:M0:41 个月 vs 24个月，P＜0。001;M1:14个月 vs 8个月，P=0。016;化疗:M0:29个月 vs 11 个月，P=0。0069;M1:13个月vs3个月，P＜0。001)。是否接受放疗对OS无影响(M0:P=0。63;M1:P=0。69)。结论 原发部位手术和化疗可同时明显改善M0和M1宫颈SCNEC的OS。年龄、种族和TNM临床分期是影响生存的独立预后因素。
Distant metastasis pattern and prognosis of cervical small cell neuroendocrine carcinoma:a retrospective study based on SEER database
Objective To investigate the distant metastasis pattern and prognosis of cervical small cell neuroendocrine carcinoma(SCNEC).Methods Clinical data of 285 patients diagnosed with SCNEC of the cervix between January 2000 and December 2018 in the Surveillance,Epidemiology,and End Results(SEER)Program of the National Cancer Institute database were retrospectively analyzed.Overall survival(OS)was calculated using Kaplan-Meier method,Log-rank was applied to compare the differences between groups.Cox proportional risk regression model was used to conduct univariate and multivariate analysis to evaluate the impact of different variables on the prognosis.Results In the 35 cases of cervical SCNEC that described specific metastatic sites,the liver was the most common site of metastasis(N=7,20.0％).The median OS of the group with distant organ metastasis(M1)was significantly lower than that of the group without distant metastasis(M0)(27 months vs 10 months,P＜0.001).Age＞40 years old,black race,T4,N1,M1,without primary site surgery and chemotherapy were independent adverse prognostic factors for OS(P＜0.05).Compared with the patients without primary site surgery/chemotherapy,the median OS of patients receiving primary site surgery/chemotherapy was significantly longer(Surgery:M0:41 months vs 24 months,P＜0.001;M1:14 months vs 8 months,P=0.016;Chemotherapy:M0:29 months vs 11 months,P=0.0069;M1:13 months vs 3 months,P＜0.001).OS was not affected by radiotherapy(M0:P=0.63;M1:P=0.69).Conclusions Primary site surgery and chemotherapy can significantly improve the OS of M0 and M1 cervical SCNEC.Age,race and TNM stage were independent prognostic factors affecting survival.
small cell neuroendocrine carcinoma of the cervixtumor metastasisradiotherapychemotherapyprognosis
万方数据
维普
