Prognostic factors and treatment comparison in early-stage small cell carcinoma of the uterine cervix

Abstract

Abstract. Small cell carcinoma of the uterine cervix (SCCUC) is rare and its biologic behavior is aggressive. To analyze prognostic factors and determine optimal therapy in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA SCCUC, we retrospectively reviewed 96 patients (14 patients treated in our center and 82 patients identified by a search on PubMed) treated with radical surgery (SU), surgery plus adjuvant chemotherapy (SU+Chemo), or surgery plus adjuvant chemotherapy and radiotherapy (SU+Chemo+RT) between 1990 and 2010. Of the 96 patients, 11 patients were treated with SU, 33 with SU+Chemo, and 52 with SU+Chemo+RT. The 5-year survival rate for the 96 patients was 45%. A total of 6% (2/32) of patients had local recurrence, 75% (24/32) had distant metastases, and 19% (6/32) had both. The 5-year survival rate in stage IB1 and IB2-IIA disease was 58 and 34%, respectively (P=0.049). For patients with and without lymph node metastases (LNM), survival was 33 and 60%, respectively (P=0.045). Patients with inner 1/3 stromal invasion had a better survival than those with deep stromal invasion (DSI) (100 vs. 34%, P=0.003). Survival was not significantly different in patients treated with the above three modalities, albeit treatment selection was related to LNM (P=0.000) and DSI (P=0.027). Thus, FIGO stage, LNM and DSI are significant predictors of survival. Adjuvant therapy after SU has not improved survival compared with surgery alone. Thus, newer multimodality therapy should be evaluated.

Prognostic Factors for Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: An Institutional Experience

“…As shown in previous studies, deep stromal invasion tended to be associated with poor survival. 7,13,19,20 In our study, deep stromal invasion was also a prognostic factor in patients with early-stage disease. Patients with deep stromal invasion had a 2.9 times higher risk of cancer death (P = 0.011).…”

“…The more advanced stage is correlated with a higher risk of poorer survival. 1,3,5,7,12,13,18,19 Although FIGO stage has been identified as a strong prognostic factor, all reference groups used in previous studies were either FIGO stage I or stage I to IIA (early stage) to compare the effects of FIGO stage on survival in multivariable analysis. 3,5,7,12 The Surveillance, Epidemiology, and End Results (SEER) study showed that compared with stage I, patients with SNEC with stage IV had a 4.6 times higher risk of death (P G 0.001) and patients with stage III had a higher risk 2.4 times (P = 0.017).…”

Gynecologic Cancer InterGroup (GCIG) Consensus Review for Small Cell Carcinoma of the Cervix

“…25 However, in a report from Tian et al 26 of 96 women with stage IB1-IIA SCCC adjuvant chemotherapy after radical hysterectomy did not appear to improve the prognosis. Similar findings were reported by Cohen et al; postoperative adjuvant chemotherapy on 135 patients with stage I to stage IIA disease in an analysis of 188 cases of stage I to stage IV disease did not seem to influence outcome.…”

Surgery Versus Radiation Treatment for High-Grade Neuroendocrine Cancer of Uterine Cervix: A Surveillance Epidemiology and End Results Database Analysis

“…Reviews of the literature showed a similar local control rate for radical surgery (25%Y33%) and primary RT (6%Y25%, Table 3). 8,13,16,18,19 Surgery has the benefit of pathology information that is useful for tailoring adjuvant therapy. 20,21 On the other hand, RT has the benefit of reduced break time from chemotherapy.…”