殷卓敏等

[摘要] 目的 探讨宫颈小细胞癌（SCCC）治疗前血清肿瘤标志物表达在宫颈小细胞癌预后中的预测价值。 方法 回顾性分析2004年4月～2014年4月在浙江省肿瘤医院接受治疗的50例Ⅰ～Ⅱ期SCCC患者的临床资料，分析患者治疗前血清肿瘤标志物CA125、CA199、CEA、SCC的表达水平与患者预后的关系。采用Kaplan-Meier法进行单因素生存分析，以Log-rank test确定统计学上的显著差异，采用Cox比例风险模型进行多因素生存分析。 结果 所有患者治疗前均接受血清肿瘤标志物的检测并均接受手术及化疗。随访截至2014年9月10日，全组患者中位无进展生存时间36.4个月，1、3年及5年无进展生存率分别为64.8%、47.9%和47.9%。血清肿瘤标志物CA125、CA199、CEA、SCC阳性患者的平均无进展生存期及3、5年生存率较CA125、CA199、CEA、SCC阴性患者低。单因素分析发现治疗前血清肿瘤标志物CA125、CA199、CEA、SCC阳性及阴性患者的生存率差异无统计学意义（P > 0.05）。联合盆腔放疗及术后病理高危因素（深间质受侵、脉管瘤栓、盆腔淋巴结阳性）均可影响患者无进展生存期（P < 0.05），脉管瘤栓是影响患者预后的独立因素（OR = 4.564，P = 0.033）。 结论 目前尚不能明确治疗前血清肿瘤标志物CA125、CA199、CEA、SCC表达水平可以预测Ⅰ～Ⅱ期SCCC患者预后。血清肿瘤标志物对SCCC患者预后的影响值得临床进一步研究。

[关键词] 小细胞癌；宫颈肿瘤；肿瘤标志物；预后

[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0022-06

[Abstract] Objective To investigate the prognostic value of serum tumor markers before treatment for FIGO stage Ⅰ-Ⅱ small cell carcinoma of the cervix. Methods Clinical data of 50 patients with small cell carcinoma of the cervix （SCCC） from April 2004 to April 2014 treated in Zhejiang Cancer Hospital were analyzed retrospectively. The relationships between the expression of serum tumor markers CA125， CA199， CEA， SCC before treatment and the prognosis of patients were analyzed. Single factor analysis was performed by using the Kaplan-Meier method. The statistical significance was determined by the Log-rank test. Multi-factor survival analysis was performed by using Cox proportional hazards models. Results The serum tumor markers of patients were detected before treatment， then underwent surgery and chemotherapy. Followed-up to September 10， 2014， median progression-free survival time of all patients was 36.4 months， 1， 3 years and 5 years progression-free survival rates were 64.8%， 47.9% and 47.9% respectively. Compared with the patients with negative expression of serum tumor markers CA125， CA199， CEA and SCC， the average progression-free survival and 3， 5 years progression-free survival rate of the patients with positive expression of serum CA125， CA199， CEA， and SCC were lower. Single factor analysis showed that the difference of progression-free survival between patients with serum tumor markers CA125， CA199 and CEA， SCC positive or negative before the treatment was no statistically significant difference （P > 0.05）. Patients progression-free survival time could be affected by combination pelvic radiation therapy and postoperative pathological risk factors （depth stromal invasion， lymphovascular space invasion， pelvic lymph node involvement） （P < 0.05）. In a multivariable analysis， lymphovascular space invasion for FIGO stageⅠ-Ⅱ SCCC remained as independent prognostic factor of survival （OR = 4.564，P = 0.033）. Conclusion Currently， it is not clear that the serum tumor markers CA125， CA199， CEA， SCC expression level before treatment can predict the prognosis of patients with FIGO stageⅠ-Ⅱ SCCC，it is worthy of further study in the clinical practice.

[Key words] Small cell carcinoma；Uterine neoplasm；Tumor markers； Prognosis

宫颈小细胞癌（small cell carcinoma of the cervix，SCCC）是一种罕见的原发于宫颈的神经内分泌肿瘤，是最具侵袭性的妇科恶性肿瘤之一，预后极差。SCCC的诊断依赖于病理学检查，临床表现与一般宫颈癌相似，但不同的是其恶性生物学行为，极易发生淋巴结转移及远处转移，因此临床期待一种方式在患者治疗前能有效地预测患者复发及转移的风险，为肿瘤治疗及预后提供指导。采用非侵入性的方式获取血液标本，通过检测血清肿瘤标志物的方式监测肿瘤治疗疗效并预测肿瘤患者预后引起了临床广泛的兴趣，并且获得了可靠证据的支持。目……