Survival outcomes in patients undergoing different treatments for small cell endocrine carcinoma of the cervix: a retrospective analysis

Abstract Background To identify the optimal primary treatment strategy for small cell neuroendocrine carcinoma of the cervix (SCNECC). Methods This retrospective study included consecutive patients who received treatment for stage I-III SCNECC at Fujian Cancer Hospital from February 6, 2006 to July 30, 2019. Relapse-free survival (RFS) was analyzed using multivariate Cox proportional hazard regression. Results are shown as hazard ratio (HR) and 95% confidence interval (CI). Results The final analysis included 69 patients. Disease stage, as assessed by the 2018 FIGO criteria, was early (I–IIA) in 34 (49%) patients and advanced (IIB–IIIC) in the remaining 35 (51%) patients. Twenty patients (29%) received curative-intent radiotherapy followed by chemotherapy. The remaining 49 patients received curative surgical resection, followed by adjuvant chemotherapy in 16 (23%) patients or adjuvant chemoradiotherapy in 33 (48%) patients. Forty patients received neoadjuvant therapy prior to curative surgical resection. Within a median follow-up of 100 months (interquartile range: 59–120), recurrence or metastases occurred in 36 patients (52%). In patients with early-stage disease, the median RFS did not differ between patients undergoing curative-intent surgery vs radiotherapy (86 months, 95% CI 63–109 vs 86 months, 95% CI 56–116, P = 0.790). In patients with advanced-stage disease, there was a statistically non-significant trend for shorter median RFS in patients undergoing curative-intent surgery vs radiotherapy (61 months, 95% CI 38–85 vs 88 months, 95% CI 46–130, P = 0.590). In patients undergoing curative-intent surgery, patients with an extensive pathologic response to neoadjuvant chemotherapy had longer RFS than moderate response and minor response (P = 0.033). In multivariate Cox regression analysis, longer RFS was independently associated with extensive pathologic response to neoadjuvant therapy (HR = 0.01, 95% CI 0.00-0.41; P = 0.017) and neoadjuvant therapy (HR = 10.10, 95% CI 1.02–99.78; P = 0.048). Conclusions In patients with early-stage SCNECC, RFS did not differ patients undergoing curative-intent radiotherapy vs surgery. For advanced-stage SCNECC, curative-intent radiotherapy followed by chemotherapy seemed to be compatible with better prognosis.