Neuroendokrini karcinom grlića materice: sistematski pregled literature.
BMC cancer
Sažetak istraživanja
Pozadina Neuroendokrini karcinom grlića materice (NECC) je rijetka varijanta raka grlića materice. Prognoza žena sa NECC je loša i ne postoji standardizovana terapija za ovu vrstu maligniteta zasnovana na kontrolisanim ispitivanjima.
Metode Izvršili smo sistematsko pretraživanje literature u bazama podataka PubMed i Cochrane Central Register of Controlled Trials da identifikujemo klinička ispitivanja koja opisuju upravljanje i ishod žena sa NECC.
Rezultati Identifikovano je tri hiljade petsto trideset osam slučajeva NECC u 112 studija. Ukupni udio NECC-a među ženama sa rakom grlića materice bio je 2303/163470 (1,41%). NECC malih ćelija, NECC velikih ćelija i drugi histološki podtipovi identifikovani su u 80,4, 12,0 i 7,6% slučajeva, respektivno. Prezentacija bolesti u ranoj i kasnoj fazi bila je ravnomerno raspoređena sa 1463 (50,6%) i 1428 (49,4%) slučajeva, respektivno. Tumori su eksprimirali sinaptofizin (424/538 slučajeva; 79%), neuron-specifičnu enolazu (196/285 slučajeva; 69%), hromogranin (323/486 slučajeva; 66%) i CD56 (162/267; 61%). Najčešći primarni tretman bila je radikalna operacija u kombinaciji s kemoterapijom, bilo kao neoadjuvantna ili adjuvantna kemoterapija, opisana u 42/48 studija. Šeme primarnog liječenja zasnovane na radioterapiji u obliku radioterapije, radiokemoterapije ili radioterapije uz istovremenu ili praćenu kemoterapijom su također često korištene (15/48 studija). Ne postoji standardni režim kemoterapije za NECC, ali cisplatin/karboplatin i etopozid (EP) su bili najčešće korištena shema liječenja (24/40 studija). Sveukupno, prognoza žena sa NECC je bila loša sa srednjim preživljavanjem bez recidiva od 16 mjeseci i srednjim ukupnim preživljavanjem od 40 mjeseci. Inhibitori imunološke kontrolne tačke i ciljani agensi prijavljeni su kao aktivni u tri izvještaja o slučajevima.
Zaključak NECC je rijetka varijanta raka grlića materice sa lošom prognozom. Multimodalno liječenje radikalnom operacijom i neoadjuvantnom/adjuvantnom kemoterapijom cisplatinom i etopozidom sa ili bez radioterapije je glavni oslonac liječenja ranog stadijuma bolesti, dok je kemoterapija cisplatinom i etopozidom ili topotekanom, paklitakselom i bevacizumabom prikladna ili za žene s lokalno uznapredovalim NECC. Inhibitori imunološke kontrolne tačke mogu biti korisni, ali nedostaju kontrolirani dokazi o njihovoj djelotvornosti.
Prikaži originalni naslov i sažetak na engleskom
Neuroendocrine carcinoma of the cervix: a systematic review of the literature.
Background Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer. The prognosis of women with NECC is poor and there is no standardized therapy for this type of malignancy based on controlled trials.
Methods We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify clinical trials describing the management and outcome of women with NECC.
Results Three thousand five hundred thirty-eight cases of NECC in 112 studies were identified. The pooled proportion of NECC among women with cervical cancer was 2303/163470 (1.41%). Small cell NECC, large cell NECC, and other histological subtypes were identified in 80.4, 12.0, and 7.6% of cases, respectively. Early and late stage disease presentation were evenly distributed with 1463 (50.6%) and 1428 (49.4%) cases, respectively. Tumors expressed synaptophysin (424/538 cases; 79%), neuron-specific enolase (196/285 cases; 69%), chromogranin (323/486 cases; 66%), and CD56 (162/267; 61%). The most common primary treatment was radical surgery combined with chemotherapy either as neoadjuvant or adjuvant chemotherapy, described in 42/48 studies. Radiotherapy-based primary treatment schemes in the form of radiotherapy, radiochemotherapy, or radiotherapy with concomitant or followed by chemotherapy were also commonly used (15/48 studies). There is no standard chemotherapy regimen for NECC, but cisplatin/carboplatin and etoposide (EP) was the most commonly used treatment scheme (24/40 studies). Overall, the prognosis of women with NECC was poor with a mean recurrence-free survival of 16 months and a mean overall survival of 40 months. Immune checkpoint inhibitors and targeted agents were reported as being active in three case reports.
Conclusion NECC is a rare variant of cervical cancer with a poor prognosis. Multimodality treatment with radical surgery and neoadjuvant/adjuvant chemotherapy with cisplatin and etoposide with or without radiotherapy is the mainstay of treatment for early stage disease while chemotherapy with cisplatin and etoposide or topotecan, paclitaxel, and bevacizumab is appropriate for women with locally advanced or recurrent NECC. Immune checkpoint inhibitors may be beneficial, but controlled evidence for their efficacy is lacking.
Izvorni podaci
- DOI
- 10.1186/s12885-018-4447-x
- PMID
- 29728073
- PMCID
- PMC5935948
- Provjereno
- 2026-07-26
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