| Objective : To investigate the clinical characteristics of primary small cell tumor of endometrium and the related factors affecting its prognosis,so as to provide some reference for clinical diagnosis and treatment and research.Methods : The published literature reports on primary small cell carcinoma of endometrium in China were searched.The main search data sources were Wanfang Medical Database and China knowledge Network Database.A total of 25 Chinese literatures with complete clinical data from 2001 to 2018 were screened.The clinical data of 38 cases were summarized and analyzed,and the accuracy,misdiagnosis rate and missed diagnosis rate of diagnostic experiments were calculated respectively.the related factors that might affect the prognosis were statistically analyzed by using SPSS22.0 software cox survival regression model.Results:1.Clinical features: the average age of 38 patients was 53.43 ± 2.25 years old.The proportion of postmenopausal women was 89.47%.The incidence of irregular vaginal bleeding was the highest in the first symptoms(97.37%).The incidence of irregular uterine enlargement was 93.33% in gynecological examination.The positive rates of tumor marker CA125,CA199 were 44.44% and 16.67%,respectively,and the percentage of abnormal echo in uterine cavity was 100%,and that of uterine malignant tumor was 84.21%.Pelvic MRI describes the coincidence rate of lymph node metastasis with postoperative pathological lymph node positive rate It was 80%,and the coincidence rate between the description of deep muscle layer invasion and postoperative pathology was 100%.The coincidence rate between preoperative curettage pathology and postoperative pathological results was 47.06%,the diagnostic accuracy for simple small cell carcinoma was 87.5%,and for mixed small cell carcinoma was 11.11%.The diagnostic accuracy of immunohistochemistry in diagnosis and curettage was 100%.Postoperative pathology showed that the positive rate of thrombus,pelvic lymph node metastasis,abdominal aortic lymph node metastasis,deep muscle invasion and deep muscle invasion were 97.30%,48.65%,5.41%,86.49%,48.65%,5.41%,86.49%,48.65%,5.41%,86.49%,48.65%,5.41%,86.49%,48.65%,5.41%,86.49%.The positive rates of NSE,Syn,Ki-67,CD56,Cg A in Runda serosa were38.46%,81.81%,95.24%,54.55% and 63.33%,respectively.2.Treatment and prognosis: among the 20 patients with a total survival time of more than 1 year,5%,20%,40% and 35% of the 20 patients with total survival time were only operated,surgical chemotherapy,surgical radiotherapy,radiotherapy and chemotherapy,respectively.In the multivariate analysis of cox survival regression model,the relationship between lymph node metastasis and treatment and prognosis was 0.002 and 0.0001,respectively,which were less than 0.05,which was statistically significant.It is suggested that positive lymph nodes and non-combined adjuvant therapy after operation are independent risk factors for prognosis.Conclusions:The predilection age of primary small cell tumors of uterus was about 53 years old,and most of them were postmenopausal women.The clinical manifestations and auxiliary examination were not significantly specific than those of Endometrioid carcinoma,and the rate of diagnosis and curettage before operation was lower.However,the diagnostic accuracy of simple small cell carcinoma of uterus is high,and the accuracy of pathological diagnosis of curettage tissue can be improved by Immunohistochemical examination.This disease is prone to vascular space infiltration,and lymph node metastasis and deep muscle layer invasion are more common,the final diagnosis depends on postoperative pathology and immunohistochemistry.The most common neuroendocrine markers were NSE,CD56,Syn,Cg A positive and Syn positive.The rate is the highest.Lymph node positive and non-combined adjuvant therapy after radical resection are independent risk factors for prognosis. |
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