宫颈小细胞癌与非小细胞癌临床特征及预后的对比研究

目的:对比性研究宫颈小细胞癌(SCCC)与宫颈非小细胞癌在发病特点、临床特征、治疗方案、预后情况等方面的差异,并探究影响其预后的因素。方法:回顾性分析2003年5月至2015年6月四川大学华西第二医院收治的宫颈小细胞癌患者63例(SCCC组)和根据诊断时间及相近的FIGO分期配对的宫颈非小细胞癌(鳞癌、腺癌)患者60例(对照组)的临床病理资料及生存情况,采用Pearson卡方检验或Fisher确切概率法比较两组临床特征、治疗方案等方面的差异,Kaplan-Meier方法比较两组总体生存率及无病生存率的差异,单因素和多因素分析影响SCCC预后的因素。结果:(1)SCCC组患者初诊的中位年龄较对照组年轻(40岁vs 44岁,P=0.001),淋巴结转移率、宫旁浸润率、脉管累及率及手术切缘阳性率也均显著高于对照组(P0.05)。而在临床症状、肿块大小、诊断分期、术前治疗、术后治疗等方面比较两者差异均无统计学意义(P0.05)。(2)生存分析中,SCCC组的累积5年生存率(29.2%)与累积5年无瘤生存率(26.6%),显著低于对照组(分别为82.6%、76.7%),差异有统计学意义(P0.05)。(3)在影响SCCC预后的多因素COX多元回归分析结果显示,有淋巴结转移是影响患者5年总生存率和5年无瘤生存率的独立危险因素(HR=4.784、3.067,P0.05)。肿块直径≥4 cm是影响5年总生存率的独立危险因素(HR=3.610,P0.05)和FIGO分期(ⅠB2以上)是影响无瘤生存率的独立危险因素(HR=2.793,P0.05)。结论:SCCC患者更年轻,其临床症状、病灶外观、治疗方案等和宫颈非小细胞癌相似,但淋巴结转移率、脉管累及率、宫旁浸润率及手术切缘阳性率均显著高于宫颈非小细胞癌,预后极差。影响SCCC患者预后的主要因素为有无淋巴结转移、FIGO分期、肿块直径。

Comparatively Analysis on Clinicopathological Characteristics and Prognosis of Small Cell Carcinoma of the Cervix(SCCC) and Non-SCCC-A Single Center of Clinical Research

Objective:To investigate the differences between patients with small cell carcinoma of the cervix and other type of cervical cancer on clinicopathological characteristics,treatment,prognosis through the retrospective analysis,also study the prognostic factors in patients with SCCC.Methods:The patients with SCCC(63 cases,research group) and patients with Non-SCCC(60 cases,control group) such as squamous cell carcinoma and adenocarcinoma of cervix were chosen during May 2003 and June 2015 in department of obstetrics and gynecology,west China second university hospital.The clinical pathological and survival data were collected,sort out,checked and analyzed.Chi-square test or Fisher's exact probability method was used to compare the differences of clinical features between the two groups.The 5-year disease-free survival(DFS) rate and 5-year overall survival(OS) rate were generated using the Kaplan-Meier method.Univariate and multivariate analysis were applied to research the prognostic factors.Results:①The median age of the patients in research group was 40 years old,younger than control group whose median age was 44 years old (P =0.001).The rate of lymph node metastasis,parametrial infiltration,vascular involvement and positive surgical margins in research group were significantly higher than those of control group (P ＜ 0.05).There were no significantly differences between two groups in clinical symptoms,FIGO stage,therapeutic schedule.②In the survival analysis,the research group estimated 5-year overall survival (OS) rate (29.2％) and estimated 5-year disease-free survival rate (DFS)(26.6％) was significantly lower than those of the control group(82.6％,and 76.7％,respectively) P ＜ 0.05.③In the COX multivariate regression analysis,the results showed that the lymph node metastasis was the independent factor influencing overall survival rate and disease-free survival rate(HR =4.784、3.067,P ＜ 0.05).In addition,the tumor size was the independent factor influencing overall survival rate (HR =3.610,P ＜ 0.05),and advanced FIGO staging was the independent factor influencing disease-free survival rate (HR =2.793,P ＜ 0.05).Conclusions:The patients with SCCC were younger than other cervical cancer,and the clinical symptoms,cervical appearance,treatment between the two types are almost the same.However,The rate of lymph node metastasis,parametrial infiltration,vascular involvement and positive surgical margins in patients with SCCC were significantly higher than other cervical cancer,and the prognosis of the patients with SCCC was very poor.The main prognostic factors were lymph node metastasis,advanced FIGO stage and tumor size.