A Multicenter Study of the Importance of Systemic Chemotherapy for Patients with Small-Cell Neuroendocrine Carcinoma of the Uterine Cervix

Abstract

Aims: We investigated the prognosis of patients with small-cell neuroendocrine carcinoma of the uterine cervix (SCNEC) in relation to treatment modalities. Methods: We retrospectively reviewed the medical records and pathological reports of 102 patients who were histologically diagnosed with SCNEC at 5 different institutes. Time to progression (TTP) and overall survival (OS) were analyzed for each treatment modality. Results: Of the patients with early-stage [International Federation of Obstetrics and Gynecology (FIGO) stage IB2 or below] SCNEC, 57.8 and 79.3% underwent radical hysterectomy followed by adjuvant therapy. In advanced-stage SCNEC, concurrent chemoradiation therapy was given to 51.4% of the patients. The overall recurrence rate was 51.6%. In early- and advanced-stage SCNEC, the TTP was not different (22.3 vs. 13.3 months, p = 0.104), but the OS was different (40.7 vs. 21.4 months, p = 0.029). Parametrial involvement and lymph vascular space invasion were found to be associated with an unfavorable prognosis. Interestingly, survival was the most unfavorable in patients with early-stage SCNEC who had never received chemotherapy. FIGO stage and use of chemotherapy were identified as independent prognostic factors in SCNEC patients. Conclusions: SCNEC requires systemic chemotherapy as part of the initial treatment, along with surgery or radiation, even in patients with early-stage disease.

Clinicopathological Aspects of Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: a Multicenter Retrospective Study and Meta-Analysis

“…However, some studies have questioned the efficacy of radical surgery for this rare disease [4,11]. Our findings in the clinical group suggest that radical surgery is associated with prolonged survival, and also support the SGO recommendation.…”

Enhanced efficacy of adjuvant chemotherapy and radiotherapy in selected cases of surgically resected neuroendocrine carcinoma of the uterine cervix

“…[1,6] Due to these facts, it is imperative to identify potential prognostic factors to select these NECUC patients who might benefit the most from the current therapeutic regimens. In agreement with the previous studies, [6,7,10,20–22] we observed a prolonged median overall survival for patients with FIGO stage ≤ IIA, tumor size ≤ 4 cm, DOI ≤ 1/2, negative LNM, and negative PMI. In addition, low expression of Syn and CgA also predicted a better survival.…”

“…[18,19] Even the early-stage NECUC patients also face a dismal clinical outcome. [18,20] The current treatment options benefit only a small portion of patients. [1,6] Due to these facts, it is imperative to identify potential prognostic factors to select these NECUC patients who might benefit the most from the current therapeutic regimens.…”

Multimodal Management of Locally Advanced Neuroendocrine Cervical Carcinoma: A Single Institution Experience

“…The group of patients with stages IA to IB small cell NECC who had never received chemotherapy had a significantly poorer time to progression and OS than early and advanced-stage tumors who had received chemotherapy (P = 0.025 and P = 0.020). 24 The sequence of chemotherapy in the regimen (NAC, CRT, or adjuvant) does not seem to impact on the outcome, as far as at least 4Y6 cycles are delivered. 12 In the study by Cohen et al, there was an improvement of 3-year OS in patients with stages IIB to IVA who received a chemotherapy (neoadjuvant, adjuvant, or CRT) compared with those who did not (17.8% vs 12%; P = 0.04).…”