(P24) Patterns of Care and Outcomes in Early Stage Neuroendocrine Carcinoma of the Cervix

Abstract

Neuroendocrine small cell carcinoma (NESCC) is a rare form of cervical cancer associated with poor outcomes. When compared to other histotypes of invasive carcinoma arising in the uterine cervix, NESCC tend to present at more advanced stages, demonstrate greater frequency of regional lymph node involvement, and, stage by stage, have a worse 5-year prognosis than invasive squamous carcinomas. However, due to their rarity, consensus regarding the optimal therapeutic strategy for early stage disease is lacking. After obtaining IRB approval, all women in the National Cancer Database diagnosed with early stage (FIGO1-IIA) NESCC were identified. Coded patient demographics, tumor characteristics, and data regarding treatment were abstracted. Univariate and multivariate analyses, including Cox survival regression analyses, were performed using SPSS Version 24.0 (SPSS Inc., Chicago, IL). A total of 104 subjects with stage I-IIA NESCC whose treatment included hysterectomy were identified. Mean age at diagnosis for these women was 41 +/- 14.1 years. Stage at diagnosis for these subjects was IA (n=12), IB1 (n=46), 1B2 (n=33) and IIA (n=5). Eight subjects were reported to have IB disease not otherwise specified. Nearly half (n=50, 48.1%) were treated with a combination of hysterectomy, radiation and chemotherapy, while smaller proportions of women were treated a combination of hysterectomy and chemotherapy (n=33, 31.7%), hysterectomy alone (n=20, 19.2%) or hysterectomy with adjuvant radiotherapy (n=1, 1.0%, p<0.0001). A total of 18 patients who received radiotherapy also received brachytherapy. Of these, 8 received neoadjuvant brachytherapy while the remainder received adjuvant brachytherapy. In univariate analysis, lower stage, Caucasian or Hispanic race/ethnicity, the absence of positive lymph nodes, and negative surgical margins were each significantly associated with improved survival (all p<0.05). However, the addition of radiotherapy to treatment plans did not significantly improve outcomes (p>0.05). Furthermore, neither the timing of chemotherapy (neoadjuvant vs. adjuvant) nor type of chemotherapy used (multi-agent vs. single-agent) were associated with improved OS (p>0.05), either in unstratified univariate analyses or when subjects were stratified by treatment regimen or tumor size (>4cm vs <4 cm; p>0.05). Lastly, we found that neoadjuvant chemotherapy failed to increase the likelihood of negative surgical margins for stage IB2 tumors (p >0.05). In multivariate analyses, tumor stage and patient race were the only variables that remained significantly associated with OS (p<0.05) . Use of chemotherapy and/or radiotherapy had no influence on survival after controlling for other variables. Analysis of U.S. hospital-based data indicates that neither chemotherapy nor radiation improves outcomes of surgically resectable early stage (FIGO IA-IIA) neuroendocrine carcinomas of the uterine cervix. This finding suggests that a prospective analysis of new treatment options is warranted with the goal of optimizing outcomes and quality of life for women impacted by NESCC.