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Abstract
Introduction Neuroendocrine carcinoma of the cervix (NECC) is a rare pathological classification of cervical cancer, and is divided into small cell neuroendocrine carcinoma (SCNEC), large cell neuroendocrine carcinoma (LCNEC) and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN).
Methods This multicenter, retrospective study enrolled 288 patients. The primary outcomes were progression-free survival (PFS) and overall survival (OS). The Kaplan-Meier method and Cox proportional hazard analysis were performed to determine risk factors of PFS and OS.
Results With a median follow up of 25 months, the 5-year PFS of NECC, SCNEC, LCNEC and MiNEN was 40.2%, 40.4%, 30.3%, and 41.6%, respectively; and the 5-year OS was 45.4%, 44.0%, 32.3%, and 50.3%, respectively. In the whole cohort, it showed that LVSI (HR=1.996, 95%CI:1.275~3.126, p=0.003), NACT (HR=1.691, 95%CI: 1.040~2.748, p=0.034), and >2/3 stromal invasion (HR=2.009, 95%CI:1.222~3.303, p=0.006) were independent risk factors of PFS; age>45 (HR=1.956, 95%CI: 1.170~3.272, p=0.011), LVSI (HR=1.722, 95%CI: 1.016~2.918, p=0.043) and >2/3 stromal invasion (HR=1.778, 95%CI: 1.024~3.087, p=0.041) were independent risk factors for OS and that adjuvant chemoradiotherapy was an independent protective factor of OS (HR=0.175, 95%CI: 0.079~0.388, p<0.001).
Conclusion/Implications This multicenter retrospective study first focused on three pathological subtypes of NECC including SCNEC, LCNEC and MiNEN. SCNEC has a worse biological behavior than the other two types. Patients with MiNEN did not have better prognosis compared to patients with SCNEC and LCNEC at the same stage. LVSI and >2/3 stromal invasion and adjuvant chemoradiotherapy are prognostic factors for PFS; age, LVSI, and >2/3 stromal invasion and adjuvant chemoradiotherapy are prognostic factors for OS in patients with NECC.
The flow diagram of the study. Center1: Shengiing hospital of China medical university, Center2: Sichuan province Cancer Hospital; Center3: Peking union medical college hospital; SCNEC: small cell neuroendocrine carcinoma; LCNEC: large cell neuroendocrine carcinoma; MiNEN: mixed neuroendocrine-non-neuroendocrine neoplasm; NED: no evidence of disease; AWD: alive with disease