Primary treatment and prognostic factors of small cell neuroendocrine carcinoma of the uterine cervix: A Taiwanese Gynecologic Oncology Group study

Wang, Kung-Liahng; Chang, Ting-Chang; Jung, Shih-Ming; Chen, Chi-Hau; Cheng, Ya-Min; Wu, Hua-Hsi; Liou, Wen-Shiung; Hsu, Shih-Tien; Ou, Yu-Che; Yeh, Lian-Shung; Lai, Hung-Cheng; Huang, Chia-Yen; Chen, Tze-Chien; Chang, Chee-Jen; Lai, Chyong-Huey

doi:10.1016/j.ejca.2011.12.014

« BackEuropean Journal of Cancer

Article in Press

Primary treatment and prognostic factors of small cell neuroendocrine carcinoma of the uterine cervix: A Taiwanese Gynecologic Oncology Group study☆

Kung-Liahng Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Department of Nursing, Mackay Medicine, Nursing and Management College, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
- These authors contributed equally to this work.
Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- These authors contributed equally to this work.
Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
Chi-Hau Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
Ya-Min Cheng
- Department of Obstetrics and Gynecology, Clinical Institute of Medicine and College of Medicine, National Cheng Kung University, Tainan, Taiwan
Hua-Hsi Wu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
Wen-Shiung Liou
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Lian-Shung Yeh
- Department of Obstetrics and Gynecology, China Medical University Hospital and China Medical University College of Medicine, Taichung, Taiwan
Hung-Cheng Lai
- Department of Obstetrics and Gynecology, Triservice General Hospital and National Defense University, Taipei, Taiwan
Chia-Yen Huang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
Tze-Chien Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
Chee-Jen Chang
- Research Center of Clinical Informatics and Medical Statistics, Chang Gung University, Taoyuan, Taiwan
Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Corresponding author: Address: Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, 5 Fu-Shin St. Kueishan, Taoyuan 333, Taiwan. Tel: +886 3 328 1200; fax: +886 3 328 8252.

published online 16 January 2012.
Corrected Proof

Abstract

Background

Our aims were to investigate the treatment and clinicopathological variables in relation to prognosis in small cell neuroendocrine cervical carcinoma (SCNECC).

Patients and methods

Clinical data of SCNECC patients with International Federation of Gynaecology and Obstetrics (FIGO) stages I–IV treated between 1987 and 2009 at member hospitals of the Taiwanese Gynecologic Oncology Group (TGOG) were retrospectively reviewed.

Results

Of the 179 eligible patients, 104 were of FIGO stage I, 19 stage IIA, 23 stage IIB, 9 stage III, and 24 stage IV. The median failure-free survival (FFS) was 16.0months, and the median cancer-specific survival (CSS) was 24.8months. In multivariate analysis, FIGO stage and lymph node metastasis were selected as independent variables in stages I–IV. In stages IIB–IVB, primary treatment containing etoposide and platinum for at least 5 cycles (EP5+) (n=16) was associated with significantly better 5-year FFS (42.9% versus 11.8%, p=0.041) and CSS (45.6% versus 17.1%, p=0.035) compared to other treatments (n=40). Furthermore, concurrent chemoradiation with EP5+ (CCRT-EP5+) was associated with even better 5-year FFS (62.5% versus 13.1%, p=0.025) and CSS (75.0% versus 16.9%, p=0.016).

Conclusions

FIGO stage and lymph node metastasis are significant prognostic factors in SCNECC. In stages IIB–IVB, CCRT-EP5+ might be the treatment of choice, which could be also true for earlier stages. Despite limitations of a retrospective study spanning a long time period and heterogeneous managements, the results provide an important basis for designing future prospective studies.

Keywords: Cervical carcinoma, Small cell neuroendocrine carcinoma, Chemoradiation, Chemotherapy, Prognosis