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

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 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 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.