Abstract: Objective　To investigate the prognostic factors of cervical neuroendocrine carcinoma (NECC). Methods　Clinical data of 16 NECC patients admitted to The Third Affiliated Hospital of Guangzhou Medical University from July 2012 to August 2021 were retrospectively collected. Survival analysis was performed by Kaplan-Meier and Cox regression method. Results　The age of the patients ranged from 23 to 63 (42.94±1.2) years old, the median age was 44.5 years old, and the tumor length ranged from 1.0 to 10.0 (5.03±1.9) cm. There were 10 cases of pure NECC, 4 cases of squamous cell carcinoma with NECC, and 2 cases of adenocarcinoma with NECC. Among them, 13 patients underwent extensive total hysterectomy + bilateral adnexectomy + pelvic lymph node dissection (5 cases of them received neoadjuvant chemotherapy), 1 patient without surgery gave up therapy after receiving postoperative radiotherapy once, and 2 cases of pregnancy complicated with NECC underwent cesarean section and total hysterectomy (1 case received chemotherapy and 1 case gave up postoperative chemoradiotherapy). Sixteen patients were finally followed up for 2-97 months. Among the 15 patients receiving operation, 6 patients had no recurrence or metastasis, 1 patient survived with distant metastasis (pelvic metastasis), and 8 patients died of multiple organ failure caused by multiple metastases (4 patients with lung, liver, lumbosacral, and pelvic metastases and 4 patients with abdominal cavity, diaphragmatic angle, mediastinal, and subclavicle multiple lymph node metastases). One unoperated patient (stage ⅣB) died of multiple organ failure after 3 months of follow-up. Univariate analysis showed that age (≥40 years old), postoperative chemotherapy, pelvic lymph node metastasis, and International Federation of Genecology and Obstetrics (FIGO) stage (>stage ⅡA) were the influencing factors of progression-free survival (PFS) and overall survival (OS) (all P<0.05). Multivariate analysis of Cox regression model showed that FIGO stage > ⅡA (HR=0.168, 95%CI: 0.038-0.743, P=0.019) was the only independent factor affecting PFS, and postoperative chemotherapy (HR=5.034, 95%CI: 1.137-22.282, P=0.033) was the only independent factor affecting OS. Conclusions　The prognosis of NECC is related to tumor stage and post-operative chemotherapy. Improving the rate of early diagnosis and early treatment of tumor can benefit the survival in patients. Postoperative adjuvant chemotherapy is recommended even for early patients, which is of great significance to improve the prognosis.

Key words: Cervical cancer, Neuroendocrine carcinoma, Treatment, Prognosis

摘要： 目的　探讨影响子宫颈神经内分泌癌（NECC）预后的因素。方法　回顾性分析2012年7月至2021年8月广州医科大学附属第三医院收治的16例NECC患者的临床病理资料，进行单因素及多因素生存分析。生存率比较采用log-rank检验，用Cox比例风险模型进行多因素预后分析。结果　患者年龄23～63（42.94±1.2）岁，中位年龄44.5岁，肿瘤长径1.0～10.0（5.03±1.9）cm。单一型NECC 10例，鳞状细胞癌伴NECC 4例，腺癌伴NECC 2例。13例行广泛全子宫+双附件切除+盆腔淋巴结清扫术（其中5例接受新辅助化疗），1例未手术者仅放疗1次放弃治疗，2例妊娠合并NECC均行剖宫产+全子宫切除术（1例接受化疗，1例放弃术后放化疗）。16例患者获得最终随访，随访时间2～97个月。15例手术患者中，6例无复发及转移，1例发生盆腔转移仍带瘤生存，8例死于多发转移所致的多器官功能衰竭（4例肺、肝、腰骶椎、骨盆转移，4例腹腔、膈角、纵隔、锁骨下多发淋巴结转移）；1例未手术ⅣB期患者随访3个月因多器官功能衰竭死亡。单因素分析显示，年龄（≥40岁）、术后化疗、盆腔淋巴结转移、国际妇产科联盟（FIGO）分期（>ⅡA期）是影响无进展生存期（PFS）及总生存期（OS）的因素（均P<0.05）。Cox回归模型多因素分析表明，FIGO分期>ⅡA期（HR=0.168，95%CI：0.038～0.743，P=0.019）是影响PFS的唯一独立因素，术后化疗（HR=5.034，95%CI：1.137～22.282，P=0.033）是影响OS的唯一独立因素。结论　NECC预后与肿瘤分期及术后化疗有关，提高肿瘤早诊早治率，可使患者生存受益，即使早期患者也建议术后辅助化疗，对于改善预后具有重要意义。

关键词: 子宫颈癌, 神经内分泌癌, 治疗, 预后