Prognostic Factors And Primary Treatment For Small Cell Neuroendocrine Carcinoma Of The Uterine Cervix

Objective:To carry out the meta-analysis about the primary treatment and prognosis of small cell neuroendocrine cervical carcinoma (SCNECC).Methods:14patients who were diagnosed as small cell neuroendocrine cervical carcinoma from January1992to June2013were reviewed while26articles witch Contains66patients about small cell neuroendocrine cervical carcinoma were reviewed in PUBMED. The former and the latter patients are a total of80.Meta-analysis was carried out about the prognostic factors such as age, FIGO stage, tumor size, deep stromal invasion, tumor homology,lymph-vascular space involvement, parametrial involvement, lymph node metastasis. And the treatment effects about neoadiuvant chemotherapy(NACT),surgery, chemotherapy and radiotherapy were also checked.ResuIts:Univariate analysis of80patients with SCNECC found FIGO early-stage(Ⅰ-ⅡA) and late-stage (ⅡB-ⅣB) significantly have affected the prognosis(P=0.013)。 Multivariate COX regression analysis found FIGO stage are important prognostic factors,HR=0.278(95%CI:0.1921.607, P=0.192). The3-year survival rates for the FIGO early-stage (Ⅰ-ⅡA) and late-stage(ⅡB-ⅣB) patients were38%and14%, respectively.But the mortality risk of the latter were3.6times of the former.Single factor and multiple factors have indicated that FIGO stage was predictive of poor prognosis.Univariate analysis finded Lymph node metastasis was the significant factor of SCNECC prognosis (P=0.000), and multiple factors COX regression analysis found that lymph node metastases was the risk prognosis factor, HR=0.099(95%CI:0.0240.402, P=0.024).The lymph-vascular space involvement was significant fact of progosis (P=0.000), and multivariate COX regression analysis found that it was the same result, HR=0.113(95%CI:0.0091.488, P=0.009), a7.5-fold risk of death.In the univariate analysis, surgery can improve the prognoses(P=0.000). However, in the Cox regression, there were no significant differences among surgery (HR,2.837;95%CI:0.9008.944, P=0.075), the neoadjuvant chemotherapy (HR,2.223;95%CI:0.9375.247, P=0.070), chemotherapy(HR,0.869;95%CI:0.2902.603, P=0.802) and radiotherapy (HR,0.766;95%CI:0.3611.625, P=0.488). In the early stage of SCNECC, the combination therapeutic regimen which included surgery improved survival compared with the other combination regimen.Conclusion:FIGO stage,lymph-vascular space involvement, lymph node metastasis are significantly associated with the prognosis of SCNECC. In early-stage SCNECC, surgery was very important position, neoadjuvant chemotherapy could improve the resection rate. Postoperative adjuvant chemotherapy must be the preferred treatment regimen,But it is necessary to recieve adjuvant radiotherapy.While late-stage SCNECC recommended chemotherapy, radiation therapy, or palliative care.