Clinical Analysis Of 32 Cases Of Small Cell Neuroendocrine Carcinoma Of Uterine Cervix

Objective: To explore the clinical and pathological characteristic of small cell neuroendocrine carcinoma of the cervix(SCNECUC),and to analysis its recurrence,metastasis and prognostic factors.Methods: 47 cases of SCNECUC treated from January 2004 to December 2014 at Liaoning Cancer Hospital & Institute were reviewed,as 17 patients were lost to follow-up,so the clinical and pathological data of the remainging 30 patients were collected,analysising the clinical characteristics and survival prognosis by retrospectively analyzed.Results: The clinical and pathological features : the cardinal symptom to go to the hospital:27 cases(90%)with abnormal bleeding,1 case with the vaginal discharge increased,1 case with the pain of lumbosacral portio,1 case with tumor found in routine checkups.the median age of the comfirmed patients is 47 years old(26~73 years old).The clinical stage is based on the International Federation of Gynecology and Obstetrics(FIGO)which was published in 2009: 15 cases of stage IB1,5 cases of stage IB2,5 cases of stage IIA1,2 cases of stage IIA2,3 cases of stage IIIB.The size of the local cancer of the cervix: 10 cases(33%)are greater than 4cm,20 cases(67%)are less than or equal to 4cm? Pathological types:10 cases(33%)of pure small cell carcinoma,20 cases(67%)of mixed type carcinoma.The postoperative pathology of 25 patients : 7cases(28%)of pelvic lymph node metastasis,13 cases(52%)of the interstitial infiltration depth of cervical is greater than 1/2,10 cases(40%)of LVSI,,nobody with the transfer of the lymph node in the abdominal aorta in the postoperative pathology,and none of the patients with the palace around the uterus was invaded and had a positive vaginal cut.Treatment: 4 patients received the concurrentradiochemotherapy,6 patients received radical surgery and adjuvant chemotherapy after that,18 patients received radical operation and postoperative chemotherapy and adjuvant radiotherapy;1 patient received chemotherapy only;1 patient recrived radical surgery only.Relapse: during the follow-up period,1 case is treament without recovery,14 cases of relapse and metastasis,the median time of recurrence and metastasis was 12months(4 ~70 months);5 cases of pelvic recurrence only,another 2 cases of pelvic recurrence are with liver and intra-abdominal metastasis respectively;2 cases of intra-abdominal metastasis;2 cases of liver metastasis;the transfer of lung,brain,and pancreatic in each case,the transfer of cervical lymph nodes and supraclavicular lymph nodes in each case;12 cases died because of recurrence and metastasis,2 cases of pelvic recurrence survived with tumor,and are in a stable condition after the assessment of the imaging studies.Prognosis: the cumulative survival rates of the patients diagnosed of ACNECUC for two years and five years are 73% and 44% respectively,and the median total survival time of all the patients is 60 months.The cumulative progression free survival(PFS)for two years and five years are 60% and 33% in respectively.The median PFS is 42 months.the cumulative survival rates for 2 years of different stage:IB1 is 87%,IB2 is 69%,IIA is 71%,and IIIB is 33%.The result of single factor analysis of prognostic :there is no correlation between the neuroendocrine markers in the immune system and prognosis(P > 0.05).The result of single factor analysis of the operation patients' prognostic:The prognosis with the tranfer of pelvic lymph node is worse obviously(P= 0.020).The patients who were treated with chemotherapy for more than 4 courses could significantly prolong the disease-free survival time(P=0.035),but had no significant effect on the survival rate(P > 0.05).the disease-free survival time of IB staged by FIGO is longer than IIA obviously(P=0.026).The age of the diagnosis,the diameter of tumor,the composition of the tumor(single or mixed type of cancer),The infiltration of deep cervical stroma(? 1/2),LVSI and postoperative adjuvant chemotherapy combined with radiotherapy and neoadjuvant chemotherapy has no relation to the prognosis of the patients(P > 0.05).Conclusion: SCNECUC is a kind of malignant tumor,proning to relapse andmetastasis and has a poor prognosis.Chemotherapy is one of the main treatment methods of SCNECUC,it is suggested that the number of chemotherapy courses should be at least 4 times;For early patients,they were treated with surgery combined with postoperative adjuvant chemotherapy and radiotherapy,but adjuvant radiotherapy did not improve the prognosis of the patients,the choose of postoperative radiotherapy should be more careful.Pelvic lymph node metastasis is a poor prognostic factor of SCNECUC.