title: Prognostic factors and treatment comparison in small cell neuroendocrine cervical carcinoma.
abstract: OBJECTIVE
  To determine the clinicopathologic factors associated with survival in small cell neuroendocrine cervical cancer (SCNEC) patients.
  
  
  METHODS
  The study was approved by the ethics committee of the hospital. The records of 64 SCNEC patients from 9,474 Chinese patients with cervical cancer at the Zhejiang Cancer Hospital were reviewed. Kaplan-Meier and Cox regression methods were used for analyses.
  
  
  RESULTS
  Of 64 patients, 47 had Stages I-IIA, 12 had Stages IIB-IVA, and five had Stage IV-B disease. A total of 81.25% underwent surgery, 89.1% received chemotherapy, 62.5% received radiation, 34.4% received neoadjuvant chemotherapy (NACT), and 34.4% received concurrent chemoradiation (CCRT). The median follow-up for surviving patients was 35.7 months (range: 0.5-160), and 29 (50%) of the 58 patients with Stages I-III had either disease recurrence or progression. The median time to first relapse was 10.5 months (range: 0-88.2). The five-year overall survival of patients in Stages I-IIA and IIB-IVB disease was 54.4% and 9.8%, respectively (p = 0.001). Women with early-stage (Stages IIBIIA) disease had median survival rates of 94 months compared with 21.4 months in the advanced-stage (Stages IIB-IVB) group. In univariate analysis, advanced-stage (p = 0.001), without radical surgery (p = 0.002) and deep stromal invasion (DSI) (p = 0.000) were considered poor prognostic factors. In a multivariable analysis, tumor size > four cm (p = 0.048), postoperative radiation (p = 0.038) for early-stage patients and the FIGO stage (p = 0.040) of disease in the overall population remained as independent prognostic factor of survival.
  
  
  CONCLUSIONS
  The FIGO stage was found to be an independent prognostic factor of SCNEC. In addition, tumor size > four cm and DSI was associated with poor survival. Postoperative radiation for early-stage patients may not improve survival. The role of primary and postoperative NACT or CCRT is unclear. Clinical trials are needed.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Yin
authors.forename: A J
authors.initials: AJ
authors.lastname: Yu
authors.forename: M J
authors.initials: MJ
authors.lastname: Wu
authors.forename: J Q
authors.initials: JQ
authors.lastname: Zhu
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: J H
authors.initials: JH
authors.lastname: Chen
authors.forename: S H
authors.initials: SH
authors.lastname: Yuan
authors.forename: H
authors.initials: H
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy