Abstract
The purpose of this study was to identify the optimal local treatment modalities for International Federation of Gynecology and Obstetrics (FIGO) stage I‐II small‐cell carcinoma of the cervix (SCCC), including cancer‐directed surgery (CDS) and/or radiotherapy (RT). The Surveillance Epidemiology and End Results (SEER) database was used to identify SCCC patients from 1988 to 2012, and analyzed using Kaplan–Meier survival and Cox regression proportional hazard methods to determine factors significant for cause‐specific survival (CSS) and overall (OS). A total of 208 patients of SCCC were enrolled. The median follow‐up time was 31 months. Fifty‐eight (27.9%) patients were treated with primary CDS, 88 (42.3%) patients underwent CDS combined with RT, and 62 (29.8%) patients were treated with primary RT. Univariate and multivariate analyses showed that local treatment modalities were independent prognostic factors for CSS and OS. Patients who had undergone CDS had better CSS and OS, compared with patients who had been treated with combined CDS and RT or RT alone. The 5‐year CSS and OS of entire group was 49.8% and 46.4%, respectively. The 5‐year CSS in the groups of patients receiving CDS, CDS combined with RT, and RT alone were 67.9%, 49.7%, and 32.6%, respectively (P < 0.001). The 5‐year OS in patients treated with CDS, CDS combined with RT, and RT alone were 64.9%, 46.2%, and 28.8% (P < 0.001). Primary surgery was associated with improved CSS and OS for FIGO stage I and lymph node negative disease. Primary surgery is the most effective local treatment for FIGO stage I‐II SCCC, as adjuvant RT or radical RT does not improve survival compared to radical surgery, especially in patients with FIGO stage I and lymph node negative disease.
Highlights
Small-cell carcinoma of the cervix (SCCC) makes up approximately 2–5% of all cervical carcinomas, which shows like highly invasive and distant metastasis [1,2,3]
A total of 208 eligible patients diagnosed with SCCC were identified in the Surveillance Epidemiology and End Results (SEER) database between 1988 and 2012
We explored the effects of different local treatment modalities on survival of Federation of Gynecology and Obstetrics (FIGO) stage I–II SCCC patients based on SEER data
Summary
Small-cell carcinoma of the cervix (SCCC) makes up approximately 2–5% of all cervical carcinomas, which shows like highly invasive and distant metastasis [1,2,3]. Most studies on SCCC are comprised of limited series and case reports, making it difficult to draw conclusions on local management in early-stage SCCC [5]. Local Treatment Modalities in SCCC surgery as the standard local treatment for stage I–IIA SCCC, while chemoradiation was recommended for stage IIB–IV patients [2, 3]. Given the aggressive nature of SCCC, it is imperative to identify potential treatments that can improve the survival of these patients. The aim of the current study was to investigate the optimal local treatment modalities for in stage I–II SCCC using a population-based national registry (Surveil lance Epidemiology and End Results, SEER), which may decrease the potential for selection and surveillance biases typically associated with single-institution analysis, and provide valuable local treatment modalities for patients with SCCC
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