Article

Prognostic factors in neuroendocrine small cell cervical carcinoma

Cancer (Impact Factor: 4.89). 02/2003; 97(3):568 - 574. DOI: 10.1002/cncr.11086

ABSTRACT

BACKGROUND
The purpose of this study was to evaluate the clinical and pathologic factors associated with survival in patients with neuroendocrine (NE) cervical carcinoma.METHODS
All patients with NE cervical carcinoma diagnosed between 1979–2001 were identified from tumor registry databases at two hospitals. Data were collected from hospital charts, office records, and tumor registry files. The impact of clinical and pathologic risk factors on the survival of patients with small cell NE carcinoma of the cervix was evaluated using Kaplan–Meier life table analyses and log-rank tests. The independent prognostic factors found to be predictive of survival in univariate analysis were evaluated using Cox regression. All tests were two-tailed with P values < 0.05 considered significant.RESULTSThirty-four patients (median age, 42 years) were diagnosed with neuroendocrine cervical carcinoma, which included 21 with International Federation of Gynecology and Obstetrics (FIGO) Stage I disease, 6 with FIGO Stage II disease, 5 with FIGO Stage III disease, and 2 with FIGO Stage IV disease. Seventeen patients underwent a radical and 6 patients underwent a simple hysterectomy. Fourteen women received adjuvant therapy with pelvic radiation and/or cisplatin-based chemotherapy. Ten women received primary radiotherapy with (n = 5) or without (n = 4) chemotherapy and the remaining patient refused therapy. Women with early-stage (Stage I-IIA) disease had median survival rates of 31 months compared with 10 months in the advanced-stage (Stage IIB-IVB) group (P = 0.002). In univariate analysis, advanced stage (P = 0.002), tumor size >2 cm (P = 0.02), margin involvement (P = 0.016), pure versus a mixed histologic pattern (P = 0.04), margin status (P = 0.016), and smoking (P = 0.04) were considered poor prognostic factors. In multivariate analysis, smoking for early-stage patients and stage of disease in the overall population remained as independent prognostic factors of survival.CONCLUSIONS
Smoking and advanced stage are reported to be poor prognostic factors for survival in patients with NE small cell carcinoma of the cervix. Only those with early lesions amenable to extirpation are cured. The role of primary or postoperative radiation with or without chemotherapy is unclear and yields uniformly poor results, particularly in patients with advanced lesions. Clinical trials are needed. Cancer 2003;97:568–74. © 2003 American Cancer Society.DOI 10.1002/cncr.11086

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    • "The reason of poor survival for patients received radiotherapy after surgery is not clear; however, it can be assumed that patients receiving adjuvant radiotherapy may have more high-risk factors of recurrence such as parametrical invasion, lymphovascular invasion, and positive resection margins. Due to the limitations of SEER data, the impacts of lymphovascular invasion, depth of tumor invasion, and surgical margins etc on survival are not clear [14, 15]. Hence, we could not determine the reason to receive adjuvant radiotherapy after CDS for SCCC patients. "
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    • "Initial treatment usually consists of surgery with radical hysterectomy and regional lymphadenectomy followed by adjuvant chemotherapy along with consideration for adjuvant radia- tion [10, 11, 17, 19]. The chemotherapy regimens that have been the most widely studied include etoposide/cisplatin (EP), vincristine/doxorubicin/cyclophosphamide (VAC), and alternating VAC/EP regimens [5]. Although the addition of radiation is often recommended, the survival benefit of adjuvant radiotherapy is poorly defined [20]. "
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    • "One of the causes of small cell carcinoma of the uterine cervix is HPV infection, and in particular, HPV type 18 is closely associated [8]. Clinically, small cell carcinoma of the uterine cervix has similar characteristics with small cell lung carcinoma [6]. About 60% of SmCC is diagnosed in International Federation of Gynecology and Obstetrics (FIGO) stages I and II. "
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