Article

Patterns of Care and Outcomes in Early Stage Neuroendocrine Carcinoma of the Uterine Cervix

 

Alison K. Yoder1, Shraddha M. Dalwadi MD, MBA2, Clark M. Dorman3, Tracilyn R. Hall, MD4,5, Matthew L. Anderson, MD, PhD4,5, Michelle S. Ludwig, MD, MPH, PhD2,4

 

1Baylor College of Medicine, Houston, Texas 77030 USA

2Baylor College of Medicine, Department of Radiation Oncology, Houston, Texas 77030 USA

3University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas 77030 USA

4Baylor College of Medicine Obstetrics & Gynecology, Houston, Texas 77030 USA

5Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas 77030 USA

 

Correspondence should be sent to:

Michelle S. Ludwig, MD, MPH, PhD

713-566-3600 (p), 713-566-3758 (f). Department of Radiation Oncology, One Baylor Plaza, MS BCM711, Houston, Texas 77030. Michelle.ludwig@bcm.edu    

 

Conflicts of interest:

No actual or potential conflicts of interest exist and there are no financial disclosures

 

Abstract:

Objective: High-grade neuroendocrine carcinoma (HNEC) is a rare form of cervical cancer associated with poor outcomes.  We aimed to examine whether the addition of chemotherapy or radiation to hysterectomy for treatment of early stage HNEC improved patient survival.

Methods/Materials: All women in the National Cancer Database diagnosed with early stage (FIGO I-IIA) HNEC were identified. Coded patient demographics, tumor characteristics, and data regarding treatment were abstracted. Cox univariate and multivariate survival analyses were performed using SPSS Version 24.0.

Results: A total of 104 subjects with stage I-IIA HNEC whose treatment included hysterectomy were identified. Mean age of these subjects was 41 + 14.1 years and median follow-up length was 47 months. Nearly half of subjects (n=50, 48.1%) were treated with a combination of hysterectomy, radiation, and chemotherapy, while fewer women underwent hysterectomy and chemotherapy (n=33, 31.7%), hysterectomy alone (n=20, 19.2%) or hysterectomy followed by radiation (n=1, 1.0%). In univariate analysis, lower stage, Caucasian or Hispanic race/ethnicity, lack of lymph metastases, and negative surgical margins were associated with improved overall survival (p<0.05). Tumor stage, lymph node involvement, and race remained significantly associated with OS (p<0.05) in multivariate analysis. Use of radiotherapy or chemotherapy was not associated with improved OS (p>0.05). Furthermore, neither the timing of chemotherapy nor type of chemotherapy used resulted in improved OS (p>0.05).

Conclusions: This analysis indicates that OS for women undergoing hysterectomy for early stage HNEC is not improved by chemotherapy or radiation. Effective options for adjuvant therapy are urgently needed to improve outcomes.

 

Key Words: Neuroendocrine cervical carcinoma, radiation therapy, chemotherapy, adjuvant, neoadjuvant, survival

 

 

 

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