Prognostic factors in neuroendocrine small cell cervical carcinoma

A multivariate analysis

Authors

  • John K. Chan M.D.,

    1. Division of Gynecologic Oncology, The Chao Family Comprehensive Cancer Center, University of California–Irvine Medical Center, Orange, California
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  • Vera Loizzi M.D.,

    1. Division of Gynecologic Oncology, The Chao Family Comprehensive Cancer Center, University of California–Irvine Medical Center, Orange, California
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  • Robert A. Burger M.D.,

    1. Division of Gynecologic Oncology, The Chao Family Comprehensive Cancer Center, University of California–Irvine Medical Center, Orange, California
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  • Joanne Rutgers M.D.,

    1. Department of Pathology, Long Beach Memorial Medical Center, Long Beach, California
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  • Bradley J. Monk M.D.

    Corresponding author
    1. Division of Gynecologic Oncology, The Chao Family Comprehensive Cancer Center, University of California–Irvine Medical Center, Orange, California
    • Division of Gynecologic Oncology, The Chao Family Comprehensive Cancer Center, University of California–Irvine Medical Center, 101 The City Drive, Orange, CA 92868
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    • Fax: (714) 456-6463


Abstract

BACKGROUND

The purpose of this study was to evaluate the clinical and pathologic factors associated with survival in patients with neuroendocrine (NE) cervical carcinoma.

METHODS

All patients with NE cervical carcinoma diagnosed between 1979–2001 were identified from tumor registry databases at two hospitals. Data were collected from hospital charts, office records, and tumor registry files. The impact of clinical and pathologic risk factors on the survival of patients with small cell NE carcinoma of the cervix was evaluated using Kaplan–Meier life table analyses and log-rank tests. The independent prognostic factors found to be predictive of survival in univariate analysis were evaluated using Cox regression. All tests were two-tailed with P values < 0.05 considered significant.

RESULTS

Thirty-four patients (median age, 42 years) were diagnosed with neuroendocrine cervical carcinoma, which included 21 with International Federation of Gynecology and Obstetrics (FIGO) Stage I disease, 6 with FIGO Stage II disease, 5 with FIGO Stage III disease, and 2 with FIGO Stage IV disease. Seventeen patients underwent a radical and 6 patients underwent a simple hysterectomy. Fourteen women received adjuvant therapy with pelvic radiation and/or cisplatin-based chemotherapy. Ten women received primary radiotherapy with (n = 5) or without (n = 4) chemotherapy and the remaining patient refused therapy. Women with early-stage (Stage I-IIA) disease had median survival rates of 31 months compared with 10 months in the advanced-stage (Stage IIB-IVB) group (P = 0.002). In univariate analysis, advanced stage (P = 0.002), tumor size >2 cm (P = 0.02), margin involvement (P = 0.016), pure versus a mixed histologic pattern (P = 0.04), margin status (P = 0.016), and smoking (P = 0.04) were considered poor prognostic factors. In multivariate analysis, smoking for early-stage patients and stage of disease in the overall population remained as independent prognostic factors of survival.

CONCLUSIONS

Smoking and advanced stage are reported to be poor prognostic factors for survival in patients with NE small cell carcinoma of the cervix. Only those with early lesions amenable to extirpation are cured. The role of primary or postoperative radiation with or without chemotherapy is unclear and yields uniformly poor results, particularly in patients with advanced lesions. Clinical trials are needed. Cancer 2003;97:568–74. © 2003 American Cancer Society.

DOI 10.1002/cncr.11086

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