Prognostic factors and optimal therapy for stages I-II neuroendocrine carcinomas of the uterine cervix: A multi-center retrospective study

Mitsuya Ishikawa, Takahiro Kasamatsu, Hitoshi Tsuda, Masaharu Fukunaga, Atsuhiko Sakamoto, Tsunehisa Kaku, Toru Nakanishi, Yoko Hasumi, Takashi Iwata, Tsukasa Baba, Takayoshi Nogawa, Wataru Kudaka, Hiroshi Kaneda, Shigemitsu Ono, Fumitaka Saito, Yoshimi Taniguchi, Satoshi Okada, Mika Mizuno, Takashi Onda, Nobuo Yaegashi

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Abstract

Purpose: We aimed to determine appropriate treatment guidelines for patients with stages I-II high-grade neuroendocrine carcinomas (HGNEC) of the uterine cervix in a multicenter retrospective study. Patients and methods: We reviewed the clinicopathological features and prognoses of 93 patients with HGNEC of International Federation of Gynecology and Obstetrics (FIGO) stages I and II. All patients were diagnosed with HGNEC by central pathological review. Results: The median overall survival (OS) and disease-free survival (DFS) were 111.3. months and 47.4. months, respectively. Eighty-eight patients underwent radical surgery, and five had definitive radiotherapy. The hazard ratio (HR) for death after definitive radiotherapy to death after radical surgery was 4.74 (95% confidence interval [CI], 1.01-15.90). Of the surgery group, 18 received neoadjuvant chemotherapy. Pathological prognostic factors and optimal adjuvant therapies were evaluated for the 70 patients. Forty-one patients received adjuvant chemotherapy with etoposide-platinum (EP) or irinotecan-platinum (CPT-P). Multivariate analyses identified the invasion of lymphovascular spaces as a significant prognostic factor for both OS and DFS. Pelvic lymph node metastasis was also a prognostic factor for DFS. Adjuvant chemotherapy with an EP or CPT-P regimen appeared to improve DFS (HR = 0.27, 95% CI, 0.10-0.69). A trend toward improved OS was also observed, but was not statistically significant (HR = 0.39, 95% CI, 0.15-1.01). Conclusion: Radical surgery followed by adjuvant chemotherapy with an EP or CPT-P regimen was optimal treatment for stages I and II HGNEC of the uterine cervix.

Original languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusAccepted/In press - 2017

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Keywords

  • Adjuvant chemotherapy
  • Cervical carcinoma
  • Neuroendocrine carcinoma
  • Optimal therapy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

Ishikawa, M., Kasamatsu, T., Tsuda, H., Fukunaga, M., Sakamoto, A., Kaku, T., Nakanishi, T., Hasumi, Y., Iwata, T., Baba, T., Nogawa, T., Kudaka, W., Kaneda, H., Ono, S., Saito, F., Taniguchi, Y., Okada, S., Mizuno, M., Onda, T., & Yaegashi, N. (Accepted/In press). Prognostic factors and optimal therapy for stages I-II neuroendocrine carcinomas of the uterine cervix: A multi-center retrospective study. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2017.10.027