宫颈大细胞神经内分泌癌的诊治进展

宫颈大细胞神经内分泌癌(large cell neuroendocrine carcinoma,LCNEC)是一种罕见类型的宫颈恶性肿瘤,因其复发率高,易发生早期转移,具有高度侵袭性,故即使在早期经系统治疗,其预后也极差。宫颈LCNEC临床表现与其他类型宫颈癌无异,目前术前及术后标本的组织病理学及免疫组织化学检查是其主要的诊断方法。一部分宫颈LCNEC患者存在高危型人乳头瘤病毒(HPV)感染,但该病发生与高危型HPV感染无关。由于其独特的生物学特性,所宫颈LCNEC的预后较差,随访较其他类型宫颈癌更加频繁。宫颈LCNEC的治疗方案主要是通过回顾总结得到,目前尚无统一治疗方法。因其与宫颈小细胞神经内分癌有相似的生物学特征,所以其治疗方案主要参考宫颈小细胞神经内分泌癌,主要采用联合治疗方法,手术联合放化疗有助于提高患者的远期生存率,因此有关宫颈LCNEC的诊治研究更为迫切。

Progress of Diagnosis and Treatment of Large Cell Neuroendocrine Carcinoma of the Uterine Cervix

Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare but highly aggressive malignancy that tends to spread and recur early even in its early stage. The prognosis is very poor despite multimodal treatments. The clinical symptoms of LCNEC of the uterine cervix are similar to others kinds of cervical cancer. And the accurate diagnosis requires tissue pathology and immunohistochemistry for nueroendocrine markers. Neuroendocrine carcinomas sometimes are infected with high-risk human papillomavirus (HPV), but they are the subtype of cervical cancer that does not appear to be associated with HPV exposure. Because of the aggressive nature of LCNEC of the uterine cervix, the expert examine the patients more frequently in the postreatment period. The overwhelming majority of available data related to its treatment derive from retrospective analyses or small case series. LCNEC of the uterine cervix seem to behave similarly to their more common counterpart, small cell neuroendocrine carcinoma of the uterine cervix. So the treatment of LCNEC is refer to the small cell neuroendocrine carcinoma of the uterine cervix, which is the combination of management (surgery+chemotherapy ±radiation). The combination can prolong the life time of the patient. Because of their peculiar clinical and biological features and the lack of literature data, there is an urgent need to study LCNEC of the uterine cervix.