子宫颈小细胞神经内分泌癌30例临床分析

发布时间：2018-06-29 10:31

  本文选题：神经内分泌癌 + 小细胞肿瘤　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:探讨SCNECUC的临床及病理特点,分析其生存情况及预后因素。方法:统计2004年1月至2014年12月辽宁省肿瘤医院收治的SCNECUC病人共47例,因17例患者失访,遂收集剩余30例SCNECUC病人的临床及病理资料,回顾性分析SCNECUC病人的临床病理特点及生存预后情况。结果:临床及病理特点:27例(90%)患者以阴道异常出血为主诉就诊,1例患者以阴道分泌物增多就诊,1例患者以腰骶部疼痛就诊,1例患者为体检发现肿瘤;患者确诊时的中位年龄为47岁(26~73岁);临床分期:按照国际妇产联盟2009年的分期标准,IB1期15例,IB2期5例,IIA1期5例,IIA2期2例,IIIB期3例;肿瘤大小:子宫颈局部肿瘤直径4cm的患者共10例(33%),局部肿瘤直径≤4cm有20例(67%);病理类型:单纯小细胞癌10例(33%),混合型癌20例(67%);25例手术治疗患者的术后病理情况:盆腔淋巴结转移者7例(28%),宫颈间质浸润深度≥1/2者13例(52%),淋巴血管间隙浸润(LVSI)患者10例(40%),术后病理中未见腹主动脉旁淋巴结阳性者,无宫旁受侵及阴道切缘阳性患者。治疗方式:4例患者接受同步放化疗,6例患者接受了根治性手术及辅助化疗,18例患者行根治性手术及术后辅助放化疗,1例患者只接受全身化疗治疗,1例患者只行根治性手术的治疗。复发情况:随访期内1例病人治疗未愈,复发及转移患者14例,中位复发及转移时间为12个月(4~70个月);单独盆腔内复发5例,另2例盆腔复发的病人分别合并肝转移及腹腔内转移,腹腔内转移的患者共2例,肝脏转移者2例,肺、脑及胰腺转移的患者各1例,颈部淋巴结及锁骨上淋巴结转移者各1例;复发及转移患者中死亡12例,2例盆腔复发的患者带瘤存活,且经影像学检查评估目前病情稳定。预后情况:SCNECUC患者的2年累积总生存率为73%,5年累积总生存率为44%,全部患者中位总生存的时间为60个月,2年和5年累积无进展生存率分别为60%和33%,中位无进展生存时间为42个月,不同分期患者的2年累积总生存率:IB1期87%,IB2期60%,IIA期71%,IIIB期33%。预后的单因素分析结果:免疫组化中神经内分泌标记物与预后无关(P0.05)。手术病人预后的单因素分析结果:盆腔淋巴结的转移者的预后明显较差(P=0.020);化疗疗程数≥4疗程的患者可显著延长无进展生存时间(P=0.035),但对于患者的生存率无显著影响(P0.05);FIGO分期IB期病人的无进展生存时间明显长于IIA期(P=0.026);确诊时的年龄、肿瘤的直径、肿瘤成分(单一型癌或混合型癌)、宫颈深间质浸润(≥1/2)、LVSI、术后辅助化疗时联合放疗及新辅助化疗与患者预后无关(P0.05)。结论:SCNECUC是一种易复发及转移且预后较差的恶性肿瘤;化疗是SCNECUC的主要治疗方式之一,建议患者至少接受4疗程的化疗治疗;对于早期的病人临床上多采用手术联合术后辅助性化疗及放疗的全面治疗方式,但术后的辅助性放疗并未改善患者的预后,对于术后放疗的选择应更加慎重;盆腔淋巴结转移是SCNECUC预后的不良因素。
[Abstract]:Objective: to investigate the clinical and pathological features of SCNECUC and analyze its survival and prognostic factors. Methods: from January 2004 to December 2014, 47 SCNECUC patients admitted to Liaoning Provincial Oncology Hospital were collected. The clinical and pathological data of the remaining 30 SCNECUC patients were collected. The clinicopathological features and survival prognosis of patients with SCNECUC were retrospectively analyzed. Results: the clinical and pathological features of 27 cases (90%) with abnormal vaginal bleeding. One patient with increased vaginal discharge, 1 patient with lumbosacral pain, and 1 patient with lumbosacral pain. The median age at the time of diagnosis was 47 years (2673 years), and the clinical stage: according to the International Federation of Obstetrics and Gynecological Federation stage 2009, 15 cases of IB1 and 5 cases of IB2 were diagnosed as IIA1, 5 cases were IIA2, 2 cases were IIA2, 3 cases were from stage IIIB. Tumor size: there were 10 cases (33%) with local tumor diameter of cervix (4cm), 20 cases (67%) with local tumor diameter 鈮，

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