Analysis Of Clinicopathological Features And Prognostic Factors Of Cervical Small Cell Neuroendocrine Carcinoma

ObjectiveTo investigate the clinicopathological characteristics of small cell neuroendocrine carcinoma of the cervix(SCNCC)and the effects of different treatment modalities on prognosis,so as to provide a reference for clinical diagnosis and treatment.MethodsThe clinicopathological data of patients with cervical small cell neuroendocrine carcinoma treated in our hospital from January 1,2010 to October 31,2021 were analyzed retrospectively,and 99 eligible cases were included.According to the clinical staging standard of the International Federation of Obstetrics and gynecology(FIGO)2009 edition,there were 74 patients with IB-IIA(74.7%)and 25 patients with IIB-IV(25.3%).All patients with stage IB-IIA included in the study were treated with radical hysterectomy + pelvic lymph node dissection,and all patients were treated with adjuvant chemotherapy after operation;Stage IIB-IV patients were treated with concurrent radiotherapy and chemotherapy.The clinicopathological data of patients were recorded in detail.According to the clinicopathological characteristics and treatment methods of patients,Kaplan Meier survival analysis and log rank test were used to compare the survival rate between groups.The variables with P < 0.05 in univariate analysis were included in Cox proportional hazards regression model for multivariate analysis.Results1.As of December 1,2021,of the 99 patients in this study,53 died and 46 survived.The median survival time is 40 months(2-143 months).The 2-year cumulative survival rate is 70.5% and the 5-year cumulative survival rate is 44.3%.2.In the whole group of patients,the results of univariate analysis: tumor diameter,FIGO stage,serum Ca125 level at the first diagnosis and serum CEA level at the first diagnosis were all related to the prognosis of patients(all P < 0.05);Further multivariate analysis showed that elevated serum Ca125 level at the first diagnosis [HR = 2.594,95% CI(1.138-5.913),P = 0.023] and advanced FIGO stage[HR = 2.294,95% CI(1.200-4.384),P = 0.012] were independent risk factors affecting the overall survival of patients with stage I-IV.3.The survival of patients undergoing surgical treatment in stage IB-IIA was analyzed.The results of univariate analysis: tumor diameter,depth of cervical interstitial invasion,lymph-vascular space invasion,lymph node status,parametrial infiltration surgical approach and number of postoperative chemotherapy courses were correlated with the prognosis(all P < 0.05).Further multivariate analysis: tumor diameter,lymph node metastasis,parametrial infiltration and the number of chemotherapy courses were independent risk factors affecting the overall survival of patients with IB-IIA(P = 0.028、P = 0.005、P = 0.002、 P = 0.010).Conclusion1.Size of tumor diameter,FIGO stage,serum Ca125 level at first diagnosis,and serum CEA level at first diagnosis are associated with the prognosis of scncc patients,and late FIGO stage and elevated serum Ca125 level at first diagnosis are independent risk factors for the prognosis of SCNCC patients.2.Tumor diameter size,lymph-vascular space invasion,depth of cervical interstitial invasion,lymph node status,parametrial invasion,surgical route,and number of chemotherapy courses are associated with the prognosis of early-stage SCNCC patients,and tumor diameter ≥ 4 cm,lymph node metastasis,parametrial invasion,and number of chemotherapy courses < 4 courses are independent risk factors for the prognosis of early-stage SCNCC patients.