Introduction Neuroendocrine carcinoma of the cervix (NECC) is a rare, aggressive histologic type of cervical cancer. This study aimed to investigate prognostic factors of NECC and compare survival outcomes according to the treatment methods.

Methods NECC patients who received primary treatment at our institution between 2000 and 2020 were retrospectively identified. We collected patients‘ clinicopathologic and survival data, including age at diagnosis, histologic subtype, stage, immunohistochemical staining results, and detailed treatment methods. Multivariate analyses were conducted to identify prognostic factors for progression-free survival (PFS) and overall survival (OS).

Results In total, 47 NECC patients were included in this analysis. The mean age at diagnosis was 46.9 years. In related to histologic subtypes, 23 (48.9%) and 7 (14.9%) were diagnosed with small cell and large cell NECCs, respectively, while 17 (36.2%) had NECC combined with other carcinomas. Patients with early-stage (2009 FIGO stage IB1), locally advanced-stage (IB2-IIIA), and distant metastasis (IVB) showed 15.6, 17.7, and 7.0 months of the median PFS, respectively, and 94.7%, 92.3%, and 15.6% of 18-month OS rates, respectively. In terms of primary treatment, 32 (68.1%) received surgical treatment. In multivariate analysis, small cell NECC (aHR, 0.297; 95% CI, 0.133–0.663; P=0.003) was identified as a favorable prognostic factors for PFS. In a subgroup of patients with stage IVB NECC, no differences in PFS and OS were observed between the chemotherapy-only and multimodal therapy groups.

Conclusion/Implications Initial FIGO stage and histologic subtypes were significant prognostic factors for survival. For patients with stage IVB disease, chemotherapy only might be preferable rather than combined therapy.