Exploring a Better Adjuvant Treatment for Surgically Treated High-Grade Neuroendocrine Carcinoma of the Cervix

Abstract

<b><i>Objectives:</i></b> The objective of this study was to explore a better adjuvant treatment for patients with high-grade (HG) neuroendocrine cervical carcinomas (NECC) who had undergone surgery as a primary treatment. <b><i>Design:</i></b> A retrospective cohort study, which involved women diagnosed as HG-NECC, was conducted in the Obstetrics and Gynecology Hospital of Fudan University. All patients had undergone radical surgery and pelvic lymphadenectomy with a laparotomy or a minimally invasive surgery. An analysis was made of the prognosis of HG-NECC. <b><i>Methods:</i></b> Overall survival (OS) and progression-free survival (PFS) curves were drawn using the Kaplan-Meier method to be compared via log-rank tests. A Cox proportional hazards model was used to estimate the independent prognostic factors. <b><i>Results:</i></b> A number of 110 patients diagnosed as HG-NECC at the pathological stage IA2 to IIIC2 according to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system were initially treated with a primary surgery between 2008 and 2020. The eligible patients had the median age of 42.5 years (range: 22–76), with the median follow-up period of 39.6 months (range: 1.0–156.6). The 5-year OS of the patients at pathological stage I, II, and III accounted for 84.9%, 85.7%, and 60.9%, respectively. The Kaplan-Meier survival curves revealed no significant differences in OS and PFS between postoperative chemoradiotherapy and chemotherapy alone (OS: <i>p</i> = 0.77; PFS: <i>p</i> = 0.41). Etoposide plus platinum therapy did not improve OS when compared with platinum plus paclitaxel therapy after surgery (<i>p</i> = 0.71). The univariable analysis showed that chemotherapy with cycles ≥4 presented a better prognosis than with cycles &#x3c;4 (OS: <i>p</i> = 0.01; HR = 6.71; PFS: <i>p</i> = 0.02; HR = 5.18). The multivariate analysis indicated that the cycles of chemotherapy (<i>p</i> = 0.02; HR 0.29) were a prognostic factor for PFS. <b><i>Limitations:</i></b> A retrospective design and the absence of partial follow-up data are limitations of the study. <b><i>Conclusions:</i></b> In initially surgically treated HG-NECC, postoperative chemotherapy alone showed no inferiority when compared with chemoradiotherapy for HG-NECC, and 4+ cycles of chemotherapy tended to produce a better prognosis than 4-ones.