宫颈神经内分泌癌临床病理特征及预后关系

蓝婷; 姚晓红; 周晓青; 石林; 侯俊; 周成敏; 刘洋; 史敏

doi:10.12182/20251160401

宫颈神经内分泌癌临床病理特征及预后关系

Clinicopathological Characteristics of Cervical Neuroendocrine Carcinoma and Their Relationship With Prognosis

摘要

摘要:
目的探讨宫颈神经内分泌癌（neuroendocrine carcinoma, NEC）临床病理特征和预后因素，明确组织学亚型，即混合性神经内分泌癌（mixed neuroendocrine carcinoma, MiNEC）与单纯神经内分泌癌（pure-NEC）的独立预后价值。
方法收集2015–2024年本院45例根治性手术+同步放化疗的宫颈NEC，利用免疫组化、HPV RNAScope原位杂交检测及生存分析评估临床病理特征及预后。采用1∶1倾向评分匹配校准FIGO分期后，获得17对均衡队列，Kaplan-Meier法和Cox模型比较MiNEC（22例）与pure-NEC（23例）的总生存（overall survival, OS）与无病生存（disease-free survival, DFS）。
结果中位年龄49岁（26～75岁），中位随访24个月，1、3、5年OS分别为75%、61%、56%。单因素分析显示FIGO Ⅲ～Ⅳ期〔风险比（hazard ratio, HR）=3.78，95%置信区间（confidence interval, CI）: 1.27～11.29，P=0.017〕及淋巴结转移（HR=3.72，95%CI: 1.13～12.19，P=0.030）为OS不良因素。倾向评分匹配后，MiNEC与pure-NEC OS预后差异无统计学意义（HR=0.80，95%CI: 0.20～3.21，P=0.583）。
结论在根治性手术联合铂-依托泊苷同步放化疗模式下，FIGO分期是宫颈NEC OS的独立预后因素。受限于样本量，组织学亚型（MiNEC与pure-NEC）与远期生存的关联尚待更大样本明确。

Abstract:
Objective To investigate the clinicopathological characteristics and prognostic factors of cervical neuroendocrine carcinoma (NEC), and to clarify the independent prognostic value of the histological subtypes—mixed NEC (MiNEC) and pure NEC.
Methods A total of 45 cases of cervical NEC treated with radical surgery plus concurrent chemoradiotherapy at our institution between 2015 and 2024 were enrolled. Their clinicopathological features and prognosis were evaluated using immunohistochemistry, HPV RNAScope in situ hybridization, and survival analysis. After 1∶1 propensity score-matched calibration for FIGO staging, 17 balanced cohorts were obtained. The overall survival (OS) and disease-free survival (DFS) were compared between the MiNEC (n = 22) and pure-NEC (n = 23) cases using the Kaplan-Meier analysis and the Cox model.
Results The median patient age was 49 years (26-75 years) and the median follow-up was 24 months. The 1-, 3-, and 5-year OS rates were 75%, 61%, and 56%, respectively. According to the univariate analysis, FIGO stages Ⅲ and Ⅳ (hazards ratio HR = 3.78, 95% CI: 1.27-11.29, P = 0.017) and lymph node metastasis (HR = 3.72, 95% CI: 1.13-12.19, P = 0.030) were identified as adverse factors for OS. After propensity score matching, the difference in prognosis between MiNEC and pure-NEC was not statistically significant (HR = 0.80, 95% CI: 0.20-3.21, P = 0.583).
Conclusion Under a treatment regimen of radical surgery combined with concurrent platinum-etoposide chemoradiotherapy, the FIGO stage is an independent prognostic factor for OS in cervical NEC. Due to the limited sample size, the association between histologic subtypes (MiNEC vs. pure-NEC) and long-term survival requires further validation with larger samples.

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