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

Abstract

The objective of this study was to assess treatment and other factors impacting survival in cervical high-grade neuroendocrine carcinoma (HGNEC). We identified patients with cervical HGNECs diagnosed during 1988 to 2012 in the Surveillance Epidemiology and End Results database. We determined overall survival by International Federation of Gynecology and Obstetrics stages and by local treatment modalities, that is, radical surgery versus external beam radiation treatment (EBRT) plus brachytherapy using Kaplan-Meier analysis with log-rank test. We also determined factors of age, stage, and treatment modality impacting survival using proportional hazard analysis. We identified 832 cases of cervical HGNECs in the database. After excluding cases with incomplete stage data, the International Federation of Gynecology and Obstetrics stages I to IV distributions were 196 (28.0%), 69 (9.9%), 175 (25.0%), and 260 patients (37.1%), respectively. Radical surgery and primary radiotherapy yielded similar 5-year overall survival for stages I (61% vs 53%, P = 0.27), II (48% vs 28%, P = 0.308), and III (33% vs 28%, P = 0.408) patients. External beam radiation treatment plus brachytherapy did not yield superior survival than EBRT alone in stage I (48% vs 49%, P = 0.799), II (37% vs 20%, P = 0.112), or III (25% vs 32%, P = 0.636) patients. Age (P = 0.004) and stage (stage II: hazard ratio [HR], 1.78, P = 0.013; stage III: HR, 2.42; P < 0.001) were independent factors impacting survival but not local treatment modality (EBRT: HR, 1.30, P = 0.17; EBRT plus brachytherapy: HR, 1.16; P = 0.417). Patients with cervical HGNECs had poor prognosis. Primary treatment by radical surgery or external beam radiotherapy with or without brachytherapy yielded equally poor survival.