title: Small cell neuroendocrine carcinoma of the cervix: analysis of the prognosis and role of radiation therapy for 43 cases.
abstract: OBJECTIVE
  To explore the outcomes and pattern of recurrence in patients with small cell neuroendocrine carcinoma of the cervix (SCNEC), and to determine the effects of adjuvant radiation therapy on survival in patients with early-stage disease.
  
  
  METHODS
  A retrospective analysis of 43 patients with SCNEC was carried out at Zhejiang Provincial Tumor Hospital between January 1985 and August 2007. All pathological specimens were examined and definitively diagnosed by two independent pathologists. The radiotherapeutic efficacy and prognosis of SCNEC were explored. Patient survival status was analyzed with the Kaplan-Meier method and survival rate was compared with the log-rank test; p < 0.05 was considered statistically significant.
  
  
  RESULTS
  Of 43 patients, 32 were early-stage and 11 were advance-stage. The median age was 45 years (range 25-85 years). There were 21 cases of metastasis or progression occurring in the lungs, retroperitoneal lymph node and brain within two years. In early-stage patients, distant metastasis or progression occurred in 13 cases within two years. The estimated 5-year survival rate for the entire group was 29%. Median overall survival for patients with early-stage disease was 89.6 months and 34.4 months for patients with advance-stage disease (p = 0.001). The 3-year survival for early-stage patients who received postoperative adjuvant chemotherapy was 57.1% compared with 56.4% for those who underwent adjuvant chemoradiotherapy, and their median survival periods were 84.7 and 89.1 months, respectively (p = 0.671).
  
  
  CONCLUSIONS
  We confirmed the unfavorable prognosis related to early nodal and hematogenous metastasis in SCNEC, resulting in a relatively poor prognosis; clinical staging was an important prognostic factor. Chemoradiotherapy may be provided for advance-stage patients. For early-stage patients, the efficacy and site of postoperative adjuvant radiotherapy need further evaluation.
authors.affiliation: Department of Gynecology Oncology, Zhejiang Cancer Hospital, Hangzhou, China. hzliunf@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Lan-Fang
authors.forename: S
authors.initials: S
authors.lastname: Hai-Yan
authors.forename: Y
authors.initials: Y
authors.lastname: Zuo-Ming
authors.forename: Z
authors.initials: Z
authors.lastname: Jian-Qing
authors.forename: C
authors.initials: C
authors.lastname: Ya-Qing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000556:secondary*; D018278:Carcinoma, Neuroendocrine / Q000473:pathology* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*
chemical_list: D005047:Etoposide; D002945:Cisplatin