Clinicopathological characteristics and prognostic factors of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix: A multicenter, retrospective study

Abstract

Abstract Objective To evaluate the prognostic factors and survival outcome of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix (NECC). Methods It was a multi-center, retrospective study that involved 98 cervical cancer patients with stage IA2-IIIC high-grade NECC. We divided them into two groups based on histology: the pure group and the mixed group. All clinicopathological variables of patients were evaluated retrospectively. Cox regression and Kaplan-Meier methods were used for analysis. Results In our study, 60 patients was in the pure group and 38 patients was in the mixed group. Via COX multivariable analysis, the mixed histology was a protective factor impacting OS (P=0.026) and progression free survival(PFS)(P=0.018) in surgically treated high-grade NECC. On the other hand, the survival outcomes were negatively impacted by ovarian reservation (OS: HR, 20.84; 95%CI, 5.02~86.57, P<0.001), age>45y(OS: HR, 4.50; 95%CI, 1.08~18.83, P=0.039), tumor size>4cm(OS: HR, 6.23; 95%CI, 2.34~16.61, P<0.001), parity>3(OS: HR, 4.50; 95%CI, 1.02~19.91, P=0.048), and perineural invasive(OS: HR, 5.21; 95%CI, 1.20~22.53, P=0.027) . The Kaplan-Meier survival curves revealed notable variances in terms of histologic type (OS: P=0.045; PFS: P=0.024), chemotherapy (OS: P=0.0056; PFS: P=0.0041), ovarian reservation (OS: P=0.00031; PFS: P=0.0023), uterus invasion (OS:P<0.0001; PFS: P<0.0001) and depth of stromal invasion (OS:P=0.043; PFS: P=0.022). Conclusions Patients with mixed histologic type who undergo surgery for NECC have a better prognosis. Meanwhile, ovarian reservation, tumor size>4cm, parity>3, age>45y and perineural invasion are poor predictors of prognosis. Patients with those high-risk factors should be taken seriously in clinical practice.