title: Patterns of recurrence and survival in neuroendocrine cervical cancer.
abstract: OBJECTIVE
  To analyze patterns of recurrence and survival and identify prognostic factors in women with neuroendocrine cervical cancer (NECC).
  
  
  METHODS
  We reviewed patients with International Federation of Gynecology and Obstetrics stage I-IVA NECC who were enrolled in the Neuroendocrine Cervical Tumor Registry and treated with curative intent. Event-free survival (EFS) and overall survival (OS) according to disease and treatment characteristics were analyzed using the Kaplan-Meier method.
  
  
  RESULTS
  Among 40 patients with NECC, 25 (62%) had small cell NECC, eight (20%) had large cell NECC, and seven (18%) had unspecified neuroendocrine histology. With a median follow-up of 21.5months, 32 patients (80%) experienced progression, and 28 (70%) died. For all patients, the 5-year EFS rate was 20%, and the 5-year OS rate was 27%. Patients with large cell NECC had significantly better median EFS (median not reached vs. 10.0months, p=0.02) and showed a trend toward better median OS (153months vs. 21months, p=0.08) than patients with other histologic types. In patients with early-stage clinically node-negative disease, chemoradiation was associated with significantly better median EFS than surgery (median not reached vs. 18.0months, p=0.04).
  
  
  CONCLUSIONS
  Patients with large cell NECC have better outcomes than patients with other subtypes of NECC. In early-stage node-negative NECC, chemoradiation yields better EFS than surgery. Most patients with NECC, even those with no evidence of nodal disease at diagnosis, rapidly develop widespread hematogenous metastases and die of their disease.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Shane R
authors.initials: SR
authors.lastname: Stecklein
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Burzawa
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Preetha
authors.initials: P
authors.lastname: Ramalingam
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Klopp
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: mfrumovitz@mdanderson.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000517:prevention & control / Q000556:secondary; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
keywords: Cervical cancer; Large cell; Neuroendocrine; Small cell