Objective: To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) . Methods: This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24); χ2=1.296, P=0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24); χ2=0.001, P=0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24); χ2=0.113, P=0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference (χ2=0.080, P=0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences (P=0.287, P=0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9%; P=0.138) and 5-year OS rate (36.1% vs 38.8%; P=0.217). Conclusions: Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.
目的： 探讨手术联合放化疗在局部晚期［国际妇产科联盟（FIGO）2018分期为Ⅰb3~Ⅳa期］子宫颈神经内分泌癌（NECC）中的价值。 方法： 本研究为单中心回顾性队列研究。收集2011年1月至2022年4月中国医学科学院北京协和医院收治的局部晚期NECC患者，按不同初始治疗方式分为同步放化疗组、手术联合放化疗组，比较两组患者的复发率；采用Kaplan-Meier法分析并比较两组患者的无进展生存（PFS）、总生存（OS）情况。 结果： （1）一般情况：共有46例Ⅰb3~Ⅳa期NECC患者纳入本研究，其中同步放化疗组22例、手术联合放化疗组24例。46例患者的诊断年龄为（46.9±10.7）岁，常见症状为阴道不规则流血（83%，38/46）、阴道排液（9%，4/46）、盆腔包块或下腹痛（4%，2/46）；共有16例（35%，16/46）患者行新辅助化疗，有效率为15/16。（2）复发：46例患者治疗后的中位随访时间为27.5个月（范围：10~106个月），随访期内26例（57%，26/46）复发，中位复发时间为11.0个月（范围：5~44个月）。按初始复发部位分类，盆腔内复发4例（9%，4/46）、盆腔外复发25例（54%，25/46），其中3例（7%，3/46）盆腔内、外均有复发。与同步放化疗组相比，手术联合放化疗组患者的盆腔内复发率［分别为14%（3/22）、4%（1/24）］有下降趋势，但两组比较，差异无统计学意义（χ2=1.296，P=0.255）；两组患者的盆腔外复发率［分别为55%（12/22）、54%（13/24）］、总复发率［分别为59%（13/22）、54%（13/24）］相似，两组分别比较，差异均无统计学意义（P均>0.05）。（3）生存结局：46例局部晚期NECC患者中，随访期内死亡22例（48%，22/46），其中同步放化疗组11例（50%，11/22）、手术联合放化疗组11例（46%，11/24），两组比较，差异无统计学意义（χ2=0.080，P=0.777）。与同步放化疗组相比，手术联合放化疗组的中位PFS时间（分别为17.0、32.0个月）和中位OS时间（分别为37.0、50.0个月）均有延长趋势，但两组分别比较，差异均无统计学意义（P=0.287，P=0.125）；两组患者的3年OS率（分别为54.2%、69.9%）、5年OS率（分别为36.1%、38.8%）相似，两组分别比较，差异均无统计学意义（P=0.138，P=0.217）。 结论： 本研究支持多模式治疗策略（包括手术、化疗、放疗）是治疗局部晚期NECC的重要组成部分，手术联合放化疗在局部晚期NECC中的治疗可能有优势，但还需多中心大样本量研究证实。.