本文選題：神經(jīng)內(nèi)分泌癌 + 小細(xì)胞腫瘤　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討SCNECUC的臨床及病理特點(diǎn),分析其生存情況及預(yù)后因素。方法:統(tǒng)計(jì)2004年1月至2014年12月遼寧省腫瘤醫(yī)院收治的SCNECUC病人共47例,因17例患者失訪,遂收集剩余30例SCNECUC病人的臨床及病理資料,回顧性分析SCNECUC病人的臨床病理特點(diǎn)及生存預(yù)后情況。結(jié)果:臨床及病理特點(diǎn):27例(90%)患者以陰道異常出血為主訴就診,1例患者以陰道分泌物增多就診,1例患者以腰骶部疼痛就診,1例患者為體檢發(fā)現(xiàn)腫瘤;患者確診時(shí)的中位年齡為47歲(26~73歲);臨床分期:按照國(guó)際婦產(chǎn)聯(lián)盟2009年的分期標(biāo)準(zhǔn),IB1期15例,IB2期5例,IIA1期5例,IIA2期2例,IIIB期3例;腫瘤大小:子宮頸局部腫瘤直徑4cm的患者共10例(33%),局部腫瘤直徑≤4cm有20例(67%);病理類型:單純小細(xì)胞癌10例(33%),混合型癌20例(67%);25例手術(shù)治療患者的術(shù)后病理情況:盆腔淋巴結(jié)轉(zhuǎn)移者7例(28%),宮頸間質(zhì)浸潤(rùn)深度≥1/2者13例(52%),淋巴血管間隙浸潤(rùn)(LVSI)患者10例(40%),術(shù)后病理中未見(jiàn)腹主動(dòng)脈旁淋巴結(jié)陽(yáng)性者,無(wú)宮旁受侵及陰道切緣陽(yáng)性患者。治療方式:4例患者接受同步放化療,6例患者接受了根治性手術(shù)及輔助化療,18例患者行根治性手術(shù)及術(shù)后輔助放化療,1例患者只接受全身化療治療,1例患者只行根治性手術(shù)的治療。復(fù)發(fā)情況:隨訪期內(nèi)1例病人治療未愈,復(fù)發(fā)及轉(zhuǎn)移患者14例,中位復(fù)發(fā)及轉(zhuǎn)移時(shí)間為12個(gè)月(4~70個(gè)月);單獨(dú)盆腔內(nèi)復(fù)發(fā)5例,另2例盆腔復(fù)發(fā)的病人分別合并肝轉(zhuǎn)移及腹腔內(nèi)轉(zhuǎn)移,腹腔內(nèi)轉(zhuǎn)移的患者共2例,肝臟轉(zhuǎn)移者2例,肺、腦及胰腺轉(zhuǎn)移的患者各1例,頸部淋巴結(jié)及鎖骨上淋巴結(jié)轉(zhuǎn)移者各1例;復(fù)發(fā)及轉(zhuǎn)移患者中死亡12例,2例盆腔復(fù)發(fā)的患者帶瘤存活,且經(jīng)影像學(xué)檢查評(píng)估目前病情穩(wěn)定。預(yù)后情況:SCNECUC患者的2年累積總生存率為73%,5年累積總生存率為44%,全部患者中位總生存的時(shí)間為60個(gè)月,2年和5年累積無(wú)進(jìn)展生存率分別為60%和33%,中位無(wú)進(jìn)展生存時(shí)間為42個(gè)月,不同分期患者的2年累積總生存率:IB1期87%,IB2期60%,IIA期71%,IIIB期33%。預(yù)后的單因素分析結(jié)果:免疫組化中神經(jīng)內(nèi)分泌標(biāo)記物與預(yù)后無(wú)關(guān)(P0.05)。手術(shù)病人預(yù)后的單因素分析結(jié)果:盆腔淋巴結(jié)的轉(zhuǎn)移者的預(yù)后明顯較差(P=0.020);化療療程數(shù)≥4療程的患者可顯著延長(zhǎng)無(wú)進(jìn)展生存時(shí)間(P=0.035),但對(duì)于患者的生存率無(wú)顯著影響(P0.05);FIGO分期IB期病人的無(wú)進(jìn)展生存時(shí)間明顯長(zhǎng)于IIA期(P=0.026);確診時(shí)的年齡、腫瘤的直徑、腫瘤成分(單一型癌或混合型癌)、宮頸深間質(zhì)浸潤(rùn)(≥1/2)、LVSI、術(shù)后輔助化療時(shí)聯(lián)合放療及新輔助化療與患者預(yù)后無(wú)關(guān)(P0.05)。結(jié)論:SCNECUC是一種易復(fù)發(fā)及轉(zhuǎn)移且預(yù)后較差的惡性腫瘤;化療是SCNECUC的主要治療方式之一,建議患者至少接受4療程的化療治療;對(duì)于早期的病人臨床上多采用手術(shù)聯(lián)合術(shù)后輔助性化療及放療的全面治療方式,但術(shù)后的輔助性放療并未改善患者的預(yù)后,對(duì)于術(shù)后放療的選擇應(yīng)更加慎重;盆腔淋巴結(jié)轉(zhuǎn)移是SCNECUC預(yù)后的不良因素。
[Abstract]:Objective: to investigate the clinical and pathological features of SCNECUC and analyze its survival and prognostic factors. Methods: from January 2004 to December 2014, 47 SCNECUC patients admitted to Liaoning Provincial Oncology Hospital were collected. The clinical and pathological data of the remaining 30 SCNECUC patients were collected. The clinicopathological features and survival prognosis of patients with SCNECUC were retrospectively analyzed. Results: the clinical and pathological features of 27 cases (90%) with abnormal vaginal bleeding. One patient with increased vaginal discharge, 1 patient with lumbosacral pain, and 1 patient with lumbosacral pain. The median age at the time of diagnosis was 47 years (2673 years), and the clinical stage: according to the International Federation of Obstetrics and Gynecological Federation stage 2009, 15 cases of IB1 and 5 cases of IB2 were diagnosed as IIA1, 5 cases were IIA2, 2 cases were IIA2, 3 cases were from stage IIIB. Tumor size: there were 10 cases (33%) with local tumor diameter of cervix (4cm), 20 cases (67%) with local tumor diameter 鈮，

本文編號(hào)：2081823