Clinicopathological characteristics and oncological outcomes of three subtypes of neuroendocrine carcinoma of the cervix: A multicenter retrospective study of 288 patients in China.

Abstract

87 Background: 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). Present literature on NECC mainly focus on SCNEC, and the clinical features of LCNEC, especially MiNEN, are not well understood. Methods: A 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%. In the whole cohort, it showed that LVSI (HR=1.996, 95%CI:1.275~3.126, p=0.003) 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. In patients undertaking surgery, it revealed that LVSI (HR=1.996, 95%CI:1.275~3.126, p=0.003) and NACT (HR=1.691, 95%CI: 1.040~2.748, p=0.034) were independent risk factors, and that adjuvant chemoradiotherapy was an independent protective factor of PFS (HR=0.201, 95%CI: 0.103~0.428, p<0.001); age>42 (HR=2.377, 95%CI: 1.417~3.986, p=0.001) and LVSI (HR=2.450, 95%CI: 1.388~4.324, p=0.002) were independent risk factors of OS, and that adjuvant chemoradiotherapy was an independent protective factor of OS (HR=0.175, 95%CI: 0.079~0.388, p<0.001). Conclusions: This multicenter retrospective study first focused on three pathological subtypes of NECC including SCNEC, LCNEC and MiNEN. 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. [Table: see text]